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<br />-',ACORD CERTIFICpTF OF LIABILITY INSUR}\"'~E 1 DATE fMMfDDfYYYY)
<br />k--~-'-TM 01/n/100S
<br />PRODUCEP (626) S99-8830 FAX ,u~bJS99-8831 THIS CERTIFICAT... ,J I~.;UED AS A MATTER OF INFORMATION
<br />Pacific General Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />40S E. Santa Clara Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Suite 100
<br />Arcadia, CA 91006 INSURERS AFFORDING COVERAGE NAIC#
<br />INSURED Mexican American Opportunity Foundation INSURER A: Philadelphia Insurance Company
<br />401 N. Garfield Avenue <1_ 75 INSURER 8:
<br />Montebello, CA 90640 A -da) I INSURER c:
<br /> A-d.o05-07fS-D:J-<f INSURER 0:
<br /> INSURER E:
<br />
<br />COVERAGES
<br />
<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 NSR TYPE OF INSURANCE POL~Y NUMBER I ~k.}i~MMID[)f'(Y DA~~ LIMITS
<br /> GENERAL LIABILITY PHPK108178 01/30/200S 01/30/2006 EACH OCCURRENCE , 1,000,001
<br /> "x COMMERCIAL GENERAL LIABILITY PREMISES Ea occure(lcel , 100,00<
<br /> I CLAIMS MADE 00 OCCUR MED EXP (Anyone person) , S,OOI
<br />. v PERSONAL.!. f..DV I~JJURY , I,OOO,GOe
<br />M ^ ~
<br /> GENERAL AGGREGATE , 3,000,000
<br /> -
<br /> GEN'l AGGREGATE liMIT APPliES PER PRODUCTS. COMP/OP AGG , 3,000,000
<br /> Xl POliCY n ~f"c?r n lOC
<br /> AUTOMOBILE LIABILITY PHPKI08178 01/30/200S 01/30/2006 COMBINED SINGLE liMIT
<br /> ~ (Ea accident) , 1,000,000
<br /> ~ ANY AUTO
<br /> All OWNED AUTOS aoOll Y INJURY
<br /> - ,
<br /> SCHEDULED AUTOS (Per person)
<br />A X -
<br /> HIRED AUTOS -$>~Dtl Y INJURY
<br /> - ,
<br /> NON-OWNED AUTOS - ~ acdden1)
<br /> - "
<br /> PROPERTY DAMAGE ,
<br /> (Peraccklent)
<br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ,
<br /> R ANY AUTO OTHER THAN EA ACC ,
<br /> AUTO ONLY: AGG ,
<br /> tSESSlUMBRELLA LIABILITY EACH OCCURRENCE ,
<br /> OCCUR 0 CLAIMS MADE AGGREGATE ,
<br /> AS C -
<br /> APPROVED 0 FORM .
<br /> R DEDUCTIBLE ::!!:Ko "01", ~/c ,
<br /> RETENTION , ,
<br /> WORKERS COMPENSATION AND . I TORY LIMITS I l'-ER'
<br /> EMPlOYERS' LIABILITY :ltJra SII14 Sh cdy
<br /> ANY PROPRIETOR/PARTNERlEXECUTIVE E.l. EACH ACCIDENT ,
<br /> OFFICEAAAEMBER EXCLUDED? __.,,>._d'_ '-.-";1 A, v,l)"::Y E.L DISEASE - EA FMPLOYEE 5
<br /> If yes, describe under
<br /> SPECIAl.. PROVISIONS below E.l. DISEASE. POLICY liMIT ,
<br /> OTHEI't PHPK108178 01/30/200S 01/30/2006 See Below
<br /> rime Coverage
<br />A rofessional liabil ity PHPKI08178 01/30/2005 01/30/2006 $1,000,000 OCC/$3,OOO,OOO OCC
<br />~~_ESCRIPTlON OF OPERATIONS' LOCATIONS' VEHtCLES, EXCLUSIONS ADDED BY ENDORSEMENT' SPECIAL PROVISIONS
<br />he City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as
<br />~dditional insured as respects to claims arising out of the operations and uses performed by or on
<br />behalf of the named insured.
<br />~ ten day Notice of Cancellation shall be given in the event of non-payment of premium.
<br />
<br />CERTIFICATE HOLDER
<br />
<br />City of Santa Ana
<br />Community Development Agency (M-2S)
<br />Attn: Carla Thompkins- Mngt. Aide
<br />P.O. Box 1988
<br />Santa Ana, CA 92702-1988
<br />
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ~ MAIL
<br />~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />-)O(~Il)(~IlIJjIl!lX'X)fJl)Q)(Il(~)O'XXX
<br />"~~JlI()llJl)l!OOl )(l{\ll!OI.JIIOIJll(<JP;lOXlX_X)(X)()(XXX)(
<br />AUTHORIZED REPRESENT A E i\ 1
<br />Michael Martin \\...;
<br />
<br />
<br />ACORD 25 (2001/08)
<br />
<br />~H(I . PA,
<br />
<br />@ACORDCORPORATION 1988
<br />
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