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c T <br />�O.3D CERTIFICATE OFBLIABILITY INSURANCEa/14>zo0,IIV,IVI,V VI4 T) <br />PRODUCER mal# 100143 <br />MAGUIRE INSURANCE AGENCY <br />THIS 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 />LIC#0377645 <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />27101 PUERTA REAL. STE 200 <br />MISSION VIEJO, CA 92691 <br />INSURERS AFFORDING COVERAGE NAIC# <br />INSURED <br />INSURER A: PHILADELPHIA INDEMNITY INSURANCE <br />INSURER D: <br />FEEDBACK FOUNDATION. INC <br />I INSURER Cl <br />1200 N KNOLLW000 CIRCLE <br />NSURER D: <br />ANAHEIM, CA 92801 <br />INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO 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 SY THE POLICES 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 />dBR <br />Aar! <br />TYPE P INSURANCE <br />POLICY NUMBER POLICY <br />EFFELTNE <br />DATE MMID <br />POLICY QPIMTION <br />b <br />LIMITS <br />DENERAL LIABILITY <br />EACH OCCURRENCE S 1,000,000 <br />DAMAGE TO REa ED s 1DO ODD <br />MED EXP n. Bram) S 5,000 <br />A <br />MERCIAL GENERAL LIABILITY <br />CLAIMS MADE IE OCCUR <br />PERSONALAAD'INJURY 3 1,000,000 <br />T.10R,10'FESSIONAL LIABILITY <br />PHPK083921 <br />07/01/2004 <br />07/01/2005 <br />0,000 AGGREGATE <br />GENERALAGOREGATE s 2,000,000 <br />GEN'. AGGREGATE LIMIT APPLIES PER <br />PRODUCT$-COMPIOPAGG $ 2000,000 <br />POLICY LOC <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(EBB mtd = 1,000,000 <br />BODILY WURY <br />X <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />PHPK083921 <br />07/01/2004 <br />07/01/2005 <br />BODILY INJURY <br />(Pn BcddmI) $ <br />X <br />X <br />HIRED AUTOS <br />NON OWNED AUTOS <br />PROPERryMAGE s <br />(Per Beew. <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT S <br />OTHER THAN RA ACC S <br />ANY AUTO <br />AUTO ONLY: AOG S " <br />A <br />LIABILITY <br />OCCUR DCIAIMSMADE <br />EACH OCCURRENCE $ 1,000,000 <br />AGGREGATE $ <br />3 <br />NRSSAIMRREULA <br />PHUB031529 <br />07/01/2004 <br />07/01/2005 <br />s <br />DEDUCTIBLE <br />S <br />RETENTION S <br />WORKERS COMPENSATION AND <br />EMPLOYERS, map ITY <br />pp <br />T�RY� TU ER <br />EL EACH ACCIDENT s <br />ANY PROPRIETOPPARTNEReXECUTNE <br />OFFICEPMEMBER EXCLUDED? <br />tt yyooxx 1g crlbe order <br />SPELUIL PROVISIONS bel. <br />EL DISEASE - EA EMPLOYEE $ <br />EL DISEASE• POLICY LIMIT $ <br />OTHER <br />BUILDING;$1,297,100 <br />PROPERTY <br />PHPK083921 <br />07/01/2004 <br />07/01/2005 <br />EMPLOYEE DISHONESTY; $100,000 <br />__jCRIME <br />THEFT INIOUT: $1,000 <br />f)MFUFTION OF OPE"IIONSIIOCATIONENE111CLE3IE%CLLMONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS <br />CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS RESPECTS TO GRANTS. <br />FORM PI -NP -003 APPLIES (ATTACHED) <br />CANCELLATION EXCEPTION: 10 DAY NOTICE FOR NON-PAYMENT OF PREMIUM <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />CITY OF SANTA ANA <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br />COMMUNITY DEVELOPMENT AGENCY M•25 <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO 00 $0 SHALL <br />P.O. BOX 1988 <br />IMPOSE NO OBLIGATION OR LM91LITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />SANTA ANA, CA 92702 <br />REPRESENTATIVES, <br />ATTN: CARLA THOMPKINS <br />AUTHORMZEDREPRESENTATNE / <br />— '`" "".' ® ACORD CORPORATION 1998 <br />