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ACQW.CERTIFICATE <br />PRODUCER <br />Advanced Insurance Marketing <br />P.O. Box 4459 <br />Orange CA 92863-4459 <br />Phone:714-997-8100 <br />INSURED <br />Casa Teresa <br />Attn: Gayle Lewis <br />123 W Map192866 <br />A8 Gve #9 <br />2 <br />Orange CCAA <br />COVERAGES <br />7 LIABILITY INSURANCE <br />DATE <br />1 HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />INSURER A: <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />NAIC # <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <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 By PAID CLAIMS. <br />LTR <br />NSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />DATE MM/DD <br />DATE MWDD <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ 1000000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE OCCUR <br />X <br />200401408NPO <br />01/09/04 <br />01/09/05 <br />PREMISES (Ea occorence) $ 100000 <br />MED EXP (Any one person) $ 10000 <br />PERSONAL 6 ADV INJURY $1000000 <br />X $0x1151 Abn80 <br />Sexual <br />GENERAL AGGREGATE $ 1000000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY jECT X LOC <br />PRODUCTS-COMP/OP AGG $1000000 <br />Em Ben. Included <br />AUTOMOBILE <br />LIABILITY <br />A <br />X <br />ANY AUTO <br />200401408NPO <br />01/09/04 <br />01/09/05 <br />COMBINED SINGLE LIMIT E 1,000,001 <br />(Ea accident) , 000, 000 <br />ALL OWNED AUTOS <br />SCHEDULEDAUTOS <br />BODILY INJURY $ <br />(Per Person) <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />BODILY INJURY S <br />(Per accident) <br />PROPERTY DAMAGE $ <br />(Per awident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />ANYAUTO <br />OTHER THAN EA ACC $ <br />AUTO ONLY: AGG S <br />A <br />EXCESS/UMBRELLA LIABILITY <br />X I OCCUR 0 CLAIMSMADE <br />200401408UMB <br />01/09/04 <br />01/09/05 <br />EACH OCCURRENCE S1,000,000 <br />AGGREGATE $ 1, 0001 000 <br />b <br />0DEDUCTIBLE <br />X RETENTION $10,000RKERS <br />a <br />$ <br />EMPLOYERS'OLIABILffY ION AND <br />y� <br />ii <br />"�' '(lt� t'T <br />RM <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT $ <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />-ge^ descdbe under <br />SPECIAL PROVISIONS belvn <br />"'—"-'-"' <br />2 <br />- `---"- <br />--- <br />E.L. DISEASE- EA EMPLOYEE $ <br />E.L. DISEASE - POLICV LIMIT S <br />OTHER <br />AssistG(1I I <br />7[V A(tpf11CV <br />DESCRIPTION <br />OF OPERATIONS (LOCATIONS / VEHICLES <br />/ EYCI uslnus enncn nv curv�eec..c.,. <br />, e <br />10 Days Notice of Cancellation for non-payment/non-reporting. City of <br />Ana and it's officers, agents & employees and volunteers are named as <br />Primary/non-contributory additional insureds per attached CG2026. RE: <br />for Pre -Natal Healthcare & Education program <br />Santa <br />Grant <br />CERTIFICATE HOLDER CANCELLATION <br />CITSANT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO <br />DATE THEREOF, THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN <br />City of Santa Ana-CDBG M-25 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />Community Development Agency <br />P.O. Box 1988 M-25 <br />Santa Ana, CA 92702 AUTHO PIR <br />,E ATNE <br />ACORD 25 (2001108) <br />