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,te, ,4/16/2004 Time, 10.01 AM To. Thompkir- Carla 9 1-714-647-6549 paae: 002-011 ACORD„ CERTIFICATE VF LIABILITY INSURANCt 04//1W2o PRODUCER (310) 393-9477 FAX (310) 393-7186 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION White & Company Insurance Inc P O Box 70 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Santa Monica, CA 90406-0070 Daren O'Neill INSURERS AFFORDING COVERAGE NAIC N INSURED Women s Transitional Living Center PO Box 6103 INSLRERA Philadelphia Ins Co INSURERS: Orange, CA 92863 INSURERC INSURER E: PYIVPPAGGS THE POLICIES OF INSURANCE LISTED BELOW RAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTNE POUCYEXPIRATIONBIC LIMITS GENERA. LIABILITY PHPK076921 04/04/2004 04/04/2005 EACHOCCURRE14CE f 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ ZOO, CLAMS MADE ❑ OCCUR MEO EP (Arty one Person) f 10, O PERSONAL & ADV INJURY F 1,000,000 A GENERAL AGGREGATE '6 2,000,000 GEM AGGREGATE LIMIT APPLIES PER PRODUCTS COMPIOP AGG 1 2,000,00 POLICY P" LOC AUTOMOBILEUPEILrn ANY AUTO PHPK076921 04/04/2004 04/04/2005 COMBINED SINGLE UNIT (Eaaca0anl) .1 1,000,000 X BODILY INJURY (Perpersm) � A ALL OWNED AUTOS SCHEDUEDAUTOS BODLYINJ (Per acciaer4) � I HIRED AUTOS NONOY.NED AUTOS PROPERTY DAMAGE (Perawd.M) I GARAGE LIABILITY AUTO ONLY -EA ACCIDENT A ANY AUTO _ OTHEEA ACC AUTO THAN AUTO ONLY AGG f f EXCESSAIMBRELLALWBX.RY PHUB029035 04/04/2004 04/04/2005 EACH OCCURRENCE i 2 000 X OCCUR CLAIMS MADE AGGREGATE 4 2,000, A $ i DEDUCTIBLE --- T I RETENTION f WORH(ERS COMPENSATION AND EMPLOYERS LWIPARTBIUTY EXECUINE ANY PROPRE BER EXCLUDED? OFFICERMEMBER EXCLUDED? W, tleboo CIALPecnROVISIONSWluw :I T" r". -. ;�. ... !/ /� WC STATLL OTH TORY LIMBS ER E L. EACH ACCIDENT $ EL. DISEASEEAEMPLOYEE t E.L. DISEASE - POLICY LIMIT 8 - OTHER --•.li, �.: DESCRIPTION OF OPERATXXIS I LOCATIONS I VEH KIESIEXCLUSKMADDEO BY ENOORSEMENTI SPECA. PROVISIONS ity of Santa Ana, its officers, agents, employees, and volunteers are additional insureds as per fo I-NP-003 (05/01) Item M - Funding Source and Primary Insurance as per form C000 01 07 98, both ttached to the general liability policy and accompanying this certificate. TExcept for 10 days written notice of cancellation for non-payment of premium. IS CERTIFICATE SUPERSEDES & CORRECTS PRIOR CERTIFICATE ISSUED 4/13/04 TO THIS CERTIFICATE HOLDER. City of Santa Ana - CDBG M-25 Attn: Carla Thompkins P.O. Box 1988 M-25 Santa Ana, CA 9270Z SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL *)6XMMK70 W1_ 30= DAYS wmTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. K03X)iDU41)Di&XWOfMi IX)ikm"K%X)Wfd00OUmmIXXXXX AUTHIORIZED REPRESENTATIVE ACORD 25 (2001/08) FAX: (714)647-6549 ©ACORD CORPORATION 1988