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s',1 CORD_ <br />CERTIFICAT- OF LIABILITY INSURAN'' - OP ID Md <br />DATE(MM/DD/YYYY) <br />HUMAOPI nO/oo/nA <br />Advanced Insurance Marketing <br />P.O. Box 4459 <br />Orange CA 92863-4459 <br />Phone: 714-997-8100 <br />A—a&or _p7,�-O/-/ <br />Human Options A--aCval - 038 <br />Ma Alderson A- aooh[-oy7 -20 <br />5540-A Trabuco Road <br />Irvine CA 92620 <br />COVERAGES <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 POLICIFS RFI nu <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURER A' Philadelphia Indemnity Ine Co. <br />INSURERS. <br />INSURER C: <br />INSURER D: <br />INSURER E: <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 CONTRACTOR 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 />NSR1 <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />DATE MWD <br />DATE MMID <br />LIMITS <br />GENERAL <br />LIABILITY <br />EACH OCCURRENCE <br />$1 OQO OOO <br />X <br />PREMISES(E'a=a enoe) <br />5100,000 <br />A <br />COMMERCIAL GENERAL LIABILITY <br />PHPK094958 <br />09/23/04 <br />09/23/05 <br />CLAIMS MADE DoccuR <br />MED EXP(Any one persm) <br />$5 Q0Q <br />PERSONAL &ADV INJURY <br />$1 000 000 <br />_ <br />GENERAL AGGREGATE <br />$2 000 000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG <br />$1r000, 0OO <br />POLICY J£CT LOCEmP <br />Ben. <br />1 OOO OOO <br />AUTOMOBILE <br />LIABILITY <br />A <br />ANY AUTO <br />PHPKO94958 <br />09/23/04 <br />O9/23/05 <br />COMBINED SINGLE LIMB <br />(Ea accident) <br />$100Q0QO <br />ALL OWNED AUTOS <br />_ <br />BODILY INJURY <br />$ <br />SCHEDULED AUTOS <br />(Par person) <br />HIRED AUTOS <br />X <br />X <br />NON -OWNED AUTOS <br />/ / <br />BODILY INJURY <br />(Per a dept) <br />$ <br />PROPERTY DAMAGE <br />$ <br />------- <br />_.-.. <br />.. <br />(Per accident) <br />GARAGE LABILfTY <br />""-` - <br />.y <br />AUTO ONLY - EA ACCIDENT <br />$ <br />ANYAUTO <br />EA ACC <br />$ <br />AUTO ONLY, <br />AUTO ONLY: AGO <br />$ <br />EXCESS/UMBRELLA LIABILITY <br />EACH OCCURRENCE <br />S_4,000, 000 <br />A <br />X� OCCUR L-1 CLAIMS MADE <br />PHUBO36035 <br />09/23/04 <br />09/23/05 <br />AGGREGATE J <br />$ 4, 000_LOO <br />DEDUCTIBLE <br />$ <br />X RETENTION $ 10 , 000 <br />$ <br />WORKERS COMPENSATION AND <br />EMPLOYERS LIABILITY <br />TORY LIMITS ER <br />EL EACH ACCIDENT <br />- <br />$ <br />ANYPROPRIETORPARTNER/EXECUTNE <br />OFFICERIMEMBER EXCLUDED? <br />E.L. DISEASE-EAEMPLOYEE <br />$ <br />i ye9� dCWIbE IIndC! <br />E.L. DISEASE- POLICY LIMIT <br />SPECIAL PROVISIONS below <br />$ <br />OTHER <br />A Crime PHPKO94958 09/23/04 09/23/05 Emp Disho 500,000 <br />Mon/Sec 10,000 <br />DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />10 Day Notice of Cancellation for non-payment/non-reporting. Certificate <br />Holder, its officers, employees, agents, volunteers and representatives are <br />named as Additional Insured per form attached. Re: Funding to provide _ <br />counseling services in the City of Santa Ana. <br />CERTIFICATE HOLDER r Amp=I I ATInM <br />CIOFSAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />City of Santa Ana <br />20 Civic Center Plaza - <br />Santa Ana, CA 92701 AUTHO ESII <br />ACORD 25 (2001108) n ACORD CORPORATION 19RR <br />PUR UCTC1J44 eri 3.24 <br />