CAMBODIAN FAMILY, THE 2A - Laserfiche WebLink

Home Browse Search

- ACC D CERTIFICATE OF LIABILITY PRODUCER (714)838 -1912 FAX (714)838 -7568 =1M&WVDD1ffYMYYY) INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION CONFERS NO RIGHTS UPON THE CERTIFICATE Lake Insurance Agency 13891 Newport Ave., Suite 285 ONLY AND HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POLICY NUMBER PHPK074625 DATE MMIDDIYY 03/09/2004 Li c #0747473 Tustin, CA 92780 INSURED Cambodian Family INSURERS AFFORDING COVERAGE INSURERA: Philadelphia Ind. Ins. Co. NAIC # — INSURER 8: $ 300,000 1111 East Wakeham Avenue INSURER C: X COMMERCIAL GENERAL LIABILITY D CLAIMS MADE a OCCUR Suite E INSURER O: Santa Ana, CA 92705 INSURER E: PERSONAL &ADVINJURY $ 1,000,000 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - LTR NSR TYPE OF INSURANCE GENERAL LIABILITY POLICY NUMBER PHPK074625 DATE MMIDDIYY 03/09/2004 DATE MMIDONY 03/09/2005 LIMITS EACH OCCURRENCE $ 1,000 000 PREMISES Ea occurence $ 300,000 X COMMERCIAL GENERAL LIABILITY D CLAIMS MADE a OCCUR MED EXP (Any one person) $ 5,000 PERSONAL &ADVINJURY $ 1,000,000 A X 0 deductible GENERAL AGGREGATE $ 3,000,000 PRODUCTS- COMPlOPAGG $ included GEN'L AGGREGATE -LIMIT APPLIES PER: X POLICY PRO JECT LOG AUTOMOBILE LIABILITY ANY AUTO PHPK074625 03/09/2004 03/09/2005 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) S A HIRED AUTOS X X NON -OWNED AUTOS $0 Deductible PROPERTY DAMAGE (Per accident) $ X GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC AUTO ONLY: AGO $ ANY AUTO $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR ❑ CLAIMS MADE DEDUCTIBLE RETENTION V, WORKERS COMPENSATION AND ... - _ ... TORY LIMITS I ER E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY - ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? `" E.LOISEASE- EAEMPLOYE S E.L. DISEASE - POLICY LIMIT $ If yes tlescrioe under SPECIAL PROVISIONS below - A OTHER Abuse & Molestation PHPK074625 03/09/2004 03/09/2005 $1,000,000 Each Claim $3,000,000 Aggregate $0 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Employee Dishonesty Liability $200,000 / 0 Ded. ertificate holder is named as additional insured per contract with named insured. Schedule of vehicles and drivers on file. '°10 day notice of cancellation due to non - payment of premium. CERTIFICATE HOLDER CANCELLATION ION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL PMX90(iYIXI MAIL *10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Santa Ana Work Center pIg�XXXxyyp�xq�q�( gQXlKgp67E 7VSQRA9[gGpXX�47(.XgpXIfXXX 1000 Santa Ana Blvd., Suite 200 x�E DP1�x7PilX7k�ERIXXR7�9(�tRXRR xXXXXXXX X Santa Ana, CA 92701 Au�HO ZE; REPRESENTATIVE 11 ACORD 25 (2001/08) v ©ACORD