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<br />. J4.CO'RD CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY) <br /> '" 04/06/2004 <br />PRODUCER (714)838-1912 FAX (714)838-7568 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Lake Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />13891 Newport Ave., Suite 285 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />L ic #0747473 <br />Tustin, CA 92780 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED Cambodian Family INSURER A: Philadelphia Ind, Ins. Co. <br /> 1111 East Wakeham Avenue INSURER B: <br /> Suite E INSURER c: <br /> Santa Ana, CA 92705 INSURER 0: <br /> INSURER E: <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED gy PAID CLAIMS. <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER O':-TE "MMfDDlY'il- DATE'IM.t6"6',w,N LIMITS <br /> GENERAL LIABILITY PHPK074625 03/09/2004 03/09/2005 EACH OCCURRENCE $ 1,000,000 <br /> 'x COMMERCIAL GENERAL LIABILITY PREMISES lEa occurence\ $ 300,000 <br /> I CLAIMS MADE [K] OCCUR MED EXP (Anyone person) $ 5,000 <br />A ~ o deductible PERSONAL & AQV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 3,000,000 <br /> I-- <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $ included <br /> !xl 'n ~RO' n <br /> X POLICY JEer LOC <br /> AUTOMOBILE LIABILITY PHPK074625 03/09/2004 03/09/2005 COMBINED SINGLE LIMIT <br /> I-- $ <br /> ANY AUTO (Ea accident) 1,000,000 <br /> I-- <br /> ALL OWNED AUTOS BOOIL Y INJURY <br /> - $ <br /> SCHEDULED AUTOS (Per person) <br />A ~ <br /> HIRED AUTOS BODILY INJURY <br /> $ <br /> ~ NON-OWNED AUTOS (Per accident) <br /> .~ $0 Deductible PROPERTY DAMAGE <br /> (Per accident) $ <br /> GARAGE LIABILlrf AUTO ONLY. EA ACCIDENT $ <br /> ==1 ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG S <br /> EXCESS/UMBRELLA LIABILITY - EACH OCCURRENCE <br /> $ <br /> ~ OCCUR D CLAIMS MADE . . " \i: AGGREGATE $ <br /> .', ,- ~ .' , ' ' .. <br /> /\, F~ r' >, (.I \ " $ <br /> =J ~EDUCTlBLE J rJj /'I ~j 1 /13 $ <br /> RETENTION $ .. $ <br /> WORKERS COMPENSATION AND (/ 1:7 ,,/ I TOR,m.'TS Ilo~. <br /> EMPLOYERS' LIABILITY ''''./''"v ,. <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ <br /> ~. <br /> OFFICER/MEMBER EXCLUDED? E.l. DISEASE. EA EMPLOYEE $ <br /> ~~~Ei~tS~R~v~s1~~s below E.L. DISEASE. POLICY LIMIT $ <br /> OTHER PHPK074625 03/09/2004 03/09/2005 $1,000,000 Each Claim <br />A ~buse & Molestation $3,000,000 Aggregate <br /> $0 Deductible <br />E~ESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />~mployee Dishonesty Liability $200,000 / 0 Ded. <br />ertificate holder is named as additional insured per contract with named insured. <br />chedule of vehicles and drivers on file. <br />'10 day notice of cancellation due to non-payment of premium. <br /> <br />Santa Ana Work Center <br />1000 Santa Ana Blvd., <br />Suite 200 <br />Santa Ana, CA 92701 <br />0:.: h CllA- 1"\014,1'\-.0 1"\.1 <br />ACORD 25 (2001/08) <br /> <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ~~ MAil <br />~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> <br />CERTIFICATE HOLDER <br /> <br /> <br />~r <br />