CAMBODIAN FAMILY, THE 4 - Laserfiche WebLink

Home Browse Search

� A ORD CERTIFICA"a Q LIABILITY INS URP III, DATE(MM/DDlYYYY) PRODUCER (714)838 -1912 FAX 04%06/2004 (714)838 -7568 THIS CERTIFICATE IJ ISSUED AS A MATTER OF INFORMATION Lake Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 13891 Newport Ave., Suite 285 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lic #0747473 Tustin, CA 92780 —� INSURERS AFFORDING COVERAGE NAIC # MDRE' Cambodian Family - - - -.— IrsuRERA NSURERB - adelphia - — Phil_Ind. Ins. Co. 1111 East Wakeham Avenue - -- Suite E INSURER(: Santa Ana, CA 92705 � INSURER D COVERAGES - THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN bSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN P.NY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAL'J, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHO`NN P.1AY FIAVE GEEN REDUCED 3Y PAID CLAIfdS. INSR ADD TYPE OF INSURANCE LTR INSR POLICY NUMBER P LI Y E TIVE P LI E %PI T - - GATE MMIDD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY PHPK074625 03 09 2004 03/09/20 COI;RAF RCIAL GENERAL LIABILI7� / / 05 EACH OCCURRENCE S 1,000,000 X CLALAS MADE �OCCJR PREMISES(EaOeeure...el $ 300,000 MED EXP (Any one Verson A X 0 deductible ) 5 5 00 GENERAL AGGREGATE $ 3'000'00( GEN'L AGGREGATE L IMIT APPLIES PER X POLICY Jt O OC PRODUCTS - COMP /OP AGG $ 7 nC1 udeC AUTOMOBILE LIABILITY PHPK074625 03/09/2004 03/09/2005 ANY AUTO COMBINED SINGLE LIMIT ALL OWNED AUTOS $ (Ea acudenU 11000,000 SCHEDULED AUTOS BODILY INJURY A X HIRED AUTOS (Per person) $ X NON- OWNEDAUTOS BODILY INJURY $ X $0 Deductible (Per accident) _ PROPERTY DAMAGE $ GARAGE LIABILITY (Per Decadent) E ANY AUTO E AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ : EXCESSlUMBRELLA LIABILITY AUTO ONLY AGG $ EACH OCCURRENCE ' OCCUR CLAIMS MADE EACH AGGREGATE $ DEDUCTIBLE $ RETENTION S / i $ WORKERS COMPENSATION AND /,I� � ).,�nL // S EMPLOY EMPLOYERS LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXEC' TIVE / E.l. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? $ If yes, describe under - - EL. DISEASE - EA EMPLOYC $ SPECIAL PROVISIONS below OTHER E.L. DISEASE -POLICY LIMIT S Abuse & Molestation PHPK074625 03/09/2004 03/09/2005 A $1,000,000 Each Claim $3,000,000 Aggregate DES( RIY NON OF OPERATIONS/ LOCATIONS /VEIIICLES/ EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS $0 Deductible mployee Dishonesty Liability $200,000 / 0 Ded. ertificate holder is named as additional insured per contract with named insured, chedule of vehicles and drivers on file. �10 day notice of cancellation due to non - payment of premium. CERTIFICATE HOLDER CANCELLATION LEXPIRATION OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Santa Ana ATE THEREOF, THE ISSUING INSURE R WILL XA SXOP MAIL Community Development Agency WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, P.O. CDBG-M-25 f�AWOV1FNlt9(D(9 X 1719A�E7F DQXl(9(X�OF90(i4X�X)i)(XX SantaP.O. Box , CA RxX" KX)OXX`P("X)QXx �X XXXXXXXXXXXXX Ana, CA 92702 / „,r„r,o, ,,.,�....�.._ -_.__ ACORD 25 (2001/08) FAX: (714)571 -1974 J ©ACORD CORP RATION 1988 — -- P PERSONAL G ADV INJURY $ $ 1,000,00( �10 day notice of cancellation due to non - payment of premium. CERTIFICATE HOLDER CANCELLATION LEXPIRATION OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Santa Ana ATE THEREOF, THE ISSUING INSURE R WILL XA SXOP MAIL Community Development Agency WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, P.O. CDBG-M-25 f�AWOV1FNlt9(D(9 X 1719A�E7F DQXl(9(X�OF90(i4X�X)i)(XX SantaP.O. Box , CA RxX" KX)OXX`P("X)QXx �X XXXXXXXXXXXXX Ana, CA 92702 / „,r„r,o, ,,.,�....�.._ -_.__ ACORD 25 (2001/08) FAX: (714)571 -1974 J ©ACORD CORP RATION 1988