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SE,~fI' 6Y: LAKE INSURANCE AGENCY; <br />7148387566; SEP-6-n~ 10:11 AM; PAGE 1;2 <br />~.~~a~- n-IR_ I»o <br />ACORQ CERTIFICATE OF LIABILITY INSURANCE ~;Jo2~ <br />PRaBULZR (714)838-1912 FAX (T14) i36-7568 <br />Lake ~ Insurance Agency <br />13891 Newport Ave., Suite 285 THL9 CERTIFICATE IS ISSUED AB A MATTER OF INFORMATION <br />ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE <br />ALT'E ER RHEC VEER tGE'AFFO~EONBYTTNE~POLlC~9EL0 . <br />Lic •0747473 <br />TUStIn, G 927b0 <br />- <br />INSURERS AFFORDING COVERAGE <br />NAIC • <br />wsuaEO Orange County C <br />dren's Therapeutic Art Cente INSURER A: Chaix/Western Neritage Ins. Co <br />- ~~ <br />208 North Broadway irauRERa: "- <br />$Anti Ani, G 92701 MSwrER G: <br /> INSURER D: <br /> INSURER F: <br />COVERAGES <br />THE POLICIE6 OF INSUfiANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80HE FCR THE POLICY PERIOD INOICAT6p. NOTIMTHSTANOING <br />ANY REOWREMENT. TERM OR GOnDD10N OF ANY CDNTRACT OR OTHER DDCUMENT YIIITiI RESPECT TO W3N:N THIS CEEITIFIGA7E MAr BE ISSUED OR <br />MAY PERTAIN, 711E INSURANCE AFFORpED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EJLCLUSIONS ANO GONg710N3 OF SUCH <br />POLICIES. AGGREGATE LM1R3 SNOVM MAY HAVE BEEN REDUCED BY PMD CLAEAS. <br />BIER TYPEOF IWUMNCE POLICY NUMBe1 POL FECIIYE EIPIRATR7N •. Ulf iE ,- <br />GENENALU,AERm $CPO571131 Da/oz~z00s O8/O2~2DO6 EACHOCGURRENCE i 1 <br />000 00 <br />% COMAIEROAL GENERAL UABLffY DAMAGE TO RENfEO 1 <br />F $Q DD <br />CLNMS MADE ~ ODCLM MED FXP (AR/ alN pBlPin) S $ OO <br />A PERSONALdAWINAMY f 1 DDD DD <br /> GENERAL AGGREGATE 3 <br />Z/D~T <br /> <br />GENE AGGREGATE UMRAPEN.]ES PER: <br />.-. <br />PROOIICT3-COMPADP AGG . <br />-... <br />i IBCllld! <br />POLICY <br />~a LM <br /> AU TDMDEIL! WIEILRV <br /> - COMBINED SINGLE LIMIT f <br /> ANV AUTD IER RCENPIID <br /> ALL OINlEO AU106 BOgLY INJURY <br /> SCHEDULEG AUiL~ (PofPeISPn) f <br /> HIRED AUTOS <br /> BODILY INJURY <br />3 <br /> NDN-0wIED AUTOS (PSrEwIdmR <br /> . <br />. PROPERTY DAMAGE <br /> . <br />. <br />._. f <br /> IPM BUraFrn) <br /> DARADE URiUTV AUTOONLY-EA ACCIDENT F <br /> ANY AUTO <br />DTKR THAN . EA ACC _ - <br /> <br />. <br /> AUTOONLY' AGG f <br /> F1fCHlNH~LIA UAmLnY EACH OCCURRENCE f <br /> OCG1R ~CWM9 M <br />ApE ~ <br /> . AGGREGATE <br />. ! <br /> .- f _ <br /> DEDUCTIBLE <br />1 ~~ <br /> RETENTION E ~S' (~ rt)~~ y ~..- <br /> WORREgEDDfIfeNEAIIONAND V,C STATLL OTK <br /> EMPLDYEM' IAAERITY ~ <br /> ' <br /> <br />ANY PRpPRIETDR.PARTNERIFJ(ECUTIVE E.L. EACH ACCIDENT S <br /> OFFlCERAENBER EACLUOED7 <br />ttgg~ <br />MEDIA MNI,r <br />- ^tX. <br />~ S _ <br />~ <br />2BC1^ <br />E.L. OEiEASE-EA EMPLOYE -"..... <br />i <br />, <br /> , <br />SPECNL P <br />O <br />S <br />O <br />S <br />Lalita SCI y <br />. - <br />-„ <br /> R <br />VI <br />I <br />N <br />PFIOB E.L. DISEASE • POLICY UNIT f <br /> DINER ~ 51>L'dD <br />~l <br />ororERAnoNar~DC~nDNEIVOECL®rESLUEwRSAmEOSrENDpu <br />Tty o Santa Ana Ts named as additi <br />l i <br />d <br />m rt <br />~ <br />v <br />~ <br />~ <br />ona <br />nsured t <br />or <br />. Origin <br />t <br />il <br />t T <br />4 al Signed fonE at tached <br />~WSubiect to 10 days notice of cancellation for non-payElent of premium. <br />rteerlcleare YlN nco <br /> ENDUED ANY OF THE ABOVE DBSCRIEED Pd-ICIIf ! GNCELLEP BEiDRE 1HE <br />THE CITY OF SANTA ANA ExrmAnoN DATE THEREDE, TN! IESUINO mauNEN wIU.10DEXXJ0Yfd6MRIL <br />ConwERnity Development Agency 30 DAVE wR1TTlN NOTICE TD TIE CERnFlDATE HOLDER NAMlD TO THE LEFT, <br />Attn: Frank Hernandez %% <br />PD 801[ 1988 ~( <br />Santa Ma, G 92702 Au ATIVE - <br />ACORD 25 (2007!06) E'AA: ~/14)b4/-bl49 <br />'~1lCORD CORPORATION 3986 <br />CdlRi .~°aTf 7~ C~rA <br />