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SPNT B.. ,AKE INSURANCE AGENCY; 7148387568; SEP-17-04 6:39PA~; PAGE 2/3 <br />n <br />CERTIFICATL JF LIABILITY INSURANCk <br />Lake Insurance Agency <br />13891 Newport Ave., Suite 285 <br />Lic N0747473 <br />Tustin, CA 92780 <br />vsuRED Orange County Chi ren s <br />208 North Broadway <br />Santa Ana, CA 92701 <br />INSURERS AFFORDING COVERAGE <br />DATE (MM'DDM'YY) <br />NAIC 0 <br />THE POLICIES OF INSURANCE LISTED BELOW HAYS BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWI7I-16TANUING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED Oft <br />MAY PERTAIN, THE INSURANCE AFFORbCb BV THE P'OLIGEB DESCRIeEb HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIOw3 AIJD CANDfTIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />lTR Tn'E OF INSURANCE POLx:Y NUMBER PATE DATE MLW UMRS <br /> GENERAL UnB1MTY SCPOSI8504 08~02~2004 oa~ozi200s EACH OCCURENCE f 1 O00 O <br /> X OOMMEACYLL GENEMLLWILRY j <br /> P $IEdomrmce $D <br /> CLNM9 MADE ~ OCCUR MEU E%P (Mr pne pbNM) j S , <br />A PERSONAL d A W INJURY j 1 Qip <br /> GENERAL AGGREGATE T 2,000 <br /> GENL AGGREGATE LFFIM~~IT APPLIES PER; PROpUCTS-COMPIOP AGG t Tnclud <br /> x POLICY JECT LOC <br /> Av roAwpaE LIABILrrr <br />fOMSINEO 91NOlE LIMIT <br /> <br />ANY AurP <br />IEa occamG j <br /> ALL OWNEP AUT09 <br /> BODLV INJURY <br />j <br /> SCHEDUI£P AURJ9 (Pm Pnian) <br /> HIRED AUTOS <br /> BOPLY INJURY t <br /> NON•PWNEO AUTOS IPx BCL1tlB11N <br /> PROPERTY MMAGE <br /> <br />P S <br /> ( <br />b dccl0mn <br /> GARAGE LIA&LRY AUTD ONIV-EA ACCIDENT S <br /> ANY AUTO <br />OTHER THAN ~'ACL <br />S <br /> AUTO ONLV~ AGG t <br /> E%GESGUMBREILALWRITV EACH OCCURRENCE t <br /> OCCUR ^ CLAIMS MADE AGGREGATE S <br /> ` <br /> OEWGTidLE / <br />l <br />( j <br /> RETFNTgN j j <br /> WORKERS COMPEMSATION ANp <br /> EMPLOYFILY LIABILffY TORY LW RS ER <br /> ANY PROPRIETORlPAATNERIE%ECUTNE <br />OFFIOER/MEMDER E% <br />L <br />DE E.L. EACH ACGOENT j <br /> Di <br />C <br />U <br />Rf!~ G,cnb. u,d.r <br />E.L. OEIEASE-EA ENPlO <br />S <br /> SPEL44 PROVISIONS bNOw E L. bLSEw9E ~ POUCV UMIT j <br />ER <br />OE$C I NOF TIDNSIL Ntl C 1 EN NT! PROM <br />ditional insured as per exhibit B attached <br />Subject to 10 days notice of cancellation for non-payment of premium. <br />rco~m,r~~ ,...... ~.. <br />THE CITY aF SANTA ANA <br />Community Development Agency <br />Attn: Carla Tompkins <br />PO BOX 1988 <br />Santa Ana, CA 92702 <br />(2001!08) FAX; <br />anuuw /VIY uA INE ADOVE OESCRIBEp PDULIp 8E GNCElLEO BEFORE THE <br />El[PIRATNIN DATE THEREOF. THE ISSUING INSURER WILL NAJL <br />~g_ DAYS WRITTEN NOTICE TO THE GERTIFM:ATE NDLDER NAKED Po THE LER. <br />~~ loczx <br />CORPORATION 1988 <br />/~~-- <br />