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<br />RPR-29-2005 11:06
<br />,
<br />
<br />THE C0~BODIRN FRMILY
<br />
<br />714 571 1'374
<br />
<br />F' . '32134
<br />
<br />.
<br />ACORQ. CERTIFICATE OF LIABILITY INSURANCE I O;~~;~)
<br /> ..n' _
<br />..oouc.. (7H)l34-1912 FAX (714)134-7561 THIS CERTIFICATE IS IS8UED AS A MATTER OF INFORMATION
<br />Lake Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br /> HOLD!fl THIS CERTIFICATE DOES NOT AMeND, eXTEND OR
<br />13891 Newport AVO!" Suite 2&5 AL Tf:R THE COVERAG~ ,y'fORDED BY THE POLlCIE8 BELOW,
<br /> ...
<br />Lie '0747473
<br />Tust;n, CA 92780 INSURERS AFFORDING COVERAGE NAle,
<br />l.suO'. caOibiidiait'fa..ny-- .... .__n. - ............ -_..._- 'Ins, -.~.
<br /> INlUMR lie Ph i1"'~,l phi a Ind. Co.
<br /> p. -;;<UY-!-087'07 ..
<br /> 1111 EAst Wakeham Avenue IHSUIltR 8: .'--
<br /> Suite E A- .;<<ld-/- i~1 --_._- .-....
<br /> lf4l1R'AC:
<br /> ..
<br /> Santa Ana, CA 92705 A- ;;;C-o'f-.;;<o3 INlLlfW' D:
<br /> ;1,- =5- O!S-bDW h.. ..-... . ..
<br /> INll,J1IR r
<br />
<br /> In
<br /> THE POLICIES OF 1N$UIlANCE LISTED 8ELOWHAVE BEEN ISSUED TO THI INSURED N.....ED ABOVE FOR THE POLICY PERIOD INDIC~TED NOTWITHSTANDING
<br />ANY REQUlItEMENT, TERM OR CONaTION OF ANY CONTRACT OR On-tER DOCUMENT WTH RESPECT TO WHICH THIS CER:TIFICATF MAY BE IS~UEO OR
<br /> OlAV PERTAI~, THE INSURANCE AF'ORDED BY THE POLICIES DESCRIBED HEREIN IS SU8JECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS or SUCH
<br />,'i':~~~u~~TE LIMITS SHOWN.....V KAVE BEEN REDUCED BY P~ID C~IM~ .. ,0..._. ..
<br />'rt: i'i.~'r TYPE a. ........c. I'OUCY NU...~._ _.. . _ ."ali! Inrc n- UMI!~._.. . !.!19.9,000
<br /> ':"........ ".."rry PHPKll044J 03/09/2005 OJ/09/2006 !ACH OCCURRENCE .
<br /> T~-'- DAii\GE'TO REII1tD . 100,00~
<br /> . ~.J (:1 AIUS WAOF l!J Qt;f'.t1R .. ._.....h~
<br /> "'ED E,lC"IMr 0fIe 1*'10'1] .
<br /> -
<br />A X 0 deduetibl e PEllUONAl & Ar:N INJI"lRV . 1,000,000
<br /> ._ ___..~ _N__.
<br /> GENEfW.. J.G.CM:GATf: I 3,000,~!l0
<br /> GEN'l,A,GGReGA.1l: LNtT .a.PPLliS PiA PROOUCT!I - COMPoOf' AGG t.~_.. included
<br /> .111.a_Lf.yO.!~d~.:..~ --
<br /> AUTOIIC)aLE UAWlY ... ....jijjPKiio443 ijjjo9)2'ociS' jji7ii9iz006 COMIIltED S1NOlE UMIT I
<br /> -. .
<br /> ANY AUrO (1!1MICWIIr't) 1,000,900
<br /> .-- AU. OMEn AlJros IIOD... y I~JUlty
<br /> SCMiOUIEO AUtos (P'.,pereon) .
<br />A X 11lRfD NJT~ .__on
<br /> 8ool'. Y INJUFlY
<br /> X HlJN.()WhED AUTOS (P.~l .
<br /> X I SO Deductible PR()PEA~-C~~~--
<br /> i 1"'1Il'~1
<br /> --.-. --.---
<br /> GAAAGE LIA.UlY NJTO OHt Y . EA ACCIDENT .
<br /> =:r ~_<A.UT~" 'n --
<br /> OTHER n-wo E"''''CC .
<br /> .~.APPROy-' D AS TO FORM. Auro ONL V AM; .
<br />..... ._-. ._-~,~_.,._..'"... ___.....__M"_._ Vj---~;, ,I
<br /> tlCCUlNIIIJW.LA ~TY A EACH OCCURRENCE .
<br /> I OCCUR r-I ""'..."""" '- t -._,.....
<br /> AOOlilEOIl.Tf .
<br /> .......-_.._---....-
<br /> Lall fa Stitt Sheed " I
<br /> :i: .~._--_.-
<br /> DfoueTIILf .
<br /> ... Mt!.nNlION Assist nt City Atto ney ...-.
<br /> I .
<br /> WORK!Q COMPENSA1lON.....D I we 'TAW-, I 10rH.
<br /> !M~O'I'EU.LI48IL.ITV TOR" LIMIT!! E~
<br /> ~N~~ROPR~T~~lN~~1XECUT~' .~_~_~~ ACCIDENT I
<br /> U"U~E.~utEltCt.uDEO' EL DISf"SE.E~_~~E .
<br /> "r.: _u_
<br />..- .Jlli.~"'~'tJ!l!'$..J!!!:!'__ .._..,_.............~_._-.'""" 'l DISCAS'. POlM:Y LWIT .
<br /> 1l.T>l.R PHPKll044J '03709i2'005- OU09/2006 S1,000,Ooo Each ClaiM
<br /> use . MOlest~tion
<br />A Sl,ooo,OOO Aggregate
<br /> SO DeGuctib1 e
<br />o~""nON Of r.~"o''', L'Ano..'.....". / EllJL~"'$8 """ED:?; EJlDOI'2""'{" ''''''jljP.OY'''r.'&o
<br />mp oyee 0 S onesty 200,000 De ,00 Pro eSSlona Li~bi ity 1. 0,000 Each,Occ/l Mil Aggregat.
<br />ertificate holder is named as additionAl insured per eon~raet with uIIled insured.
<br />chedule of vehicles and drivers on file.
<br />'Non-Profit Organization "
<br />~10 day notice of cancellation shall be given in the event of non-paYMent of premiuII
<br />
<br />C1~y of Santa Ana
<br />Community DevelopMent Agency
<br />CDBG-M-25
<br />P,O, Box 1938
<br />Santa Ana, CA 92702
<br />
<br />SHOULD ANY Of' mE A.ov! OElCAlalC I"OUCIES H CANCILU!D "FORI! THe
<br />fltJtllU,TION DATE TMIIIlEOF, TMlllSUtHC I....U.ERWlU. ~~ .....IL
<br />*10 DAys""""mt.l N011ClTOTHE CI!Imfl'IC4~ HOLl)f:Jl;NANIDTO TifE lEFT
<br />~VlU"14)Y'."""lIIl.llllx.16l~l"D.X".~MK-YA'I'...xX
<br />lID ~_XXXXXXXX
<br />
<br />
<br />CACORD CORPORATION 198&
<br />
<br />AUT" "
<br />
<br />ACORD 25 (2ot11/0S) FAX: (714)571-1974
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