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ACORD CERTIFIC. .*E JF LIABILITY <br />INSUR _N �� <br />DATE <br />to/z <br />10/2a/ooaM/D2004) <br />PRODUCER (916) 784-9070 <br />All -Cal Insurance Agency <br />801 Riverside Avenue #105 <br />ATTN: BEVERLY OR NINA <br />Roseville CA 95678- <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />VIETNAMESE COMMUNITY OF ORANGE COUNTY <br />1618 W. FIRST STREET <br />SANTA ANA CA 92703— <br />INSURER A: Nonprofits IRS Alliance <br />INSURER B: F_IDELITY 6 DEPOSIT CO. <br />INSURERC: <br />INSURER D: <br />INSURER E: <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY <br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />ADUL <br />INSRD <br />TYPEOFINSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />DATE(MWDD/YY) <br />POUCV EXPIRATION <br />DATE(MM/DD/YY) <br />LIMITS <br />A <br />X <br />GENERALLIABIUTY <br />/ / <br />/ / <br />EACH OCCURRENCE <br />$ 1,000,000 <br />PREMISES(EaEwcurrence <br />E T <br />S 50,000 <br />X COMMERCIALGENERALLIABILITY <br />CLAIMS MADE FRIOCCUR <br />2004-04575 <br />10/04/2004 <br />10/04/2005 <br />MED EXP (Any one arson) <br />$ 5,000 <br />PERSONAL B ADV INJURY <br />$ 1,000,000 <br />X PROFESSIONAL LIAR. <br />X <br />IMPROPER SEXUAL CON. <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />/ / <br />/ / <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMPIOP AGG <br />$ 2,000,000 <br />IMPROPER SEXUAL CON. <br />1,000,000 <br />7X POLICY PRO- LOC <br />JECTA <br />/ / <br />/ / <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />/ / <br />/ / <br />COMBINED SINGLE LIMIT <br />(Ea eccldent) <br />$ 1,000,000 <br />BODILY INJURY <br />(Per person) <br />$ <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />2004-04575 <br />10/04/2004 <br />10/04/2005 <br />X <br />X <br />BODILY INJURY <br />(Per accident) <br />$ <br />HIREDAUTOS <br />NON -OWNED AUTOS <br />/ / <br />/ / <br />X <br />PROPERTY DAMAGE <br />(Peracc,dent) <br />$ <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT <br />$ <br />OTHER THAN EA ACC <br />S <br />ANY AUTO <br />/ / <br />/ / <br />$ <br />AUTO ONLY: AGG <br />EXCESS/UMBRELLA LIABILITY <br />Q <br />/ / <br />/ / <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />S <br />OCCUR CLAIMS MADE <br />$ <br />DEDUCTIBLE <br />/ / <br />/ / <br />$ <br />RETENTION $ <br />WORKERS COMPENSATION AND <br />WC II IMRS OER <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ <br />E. L. DISEASE - EA EMPLOYEE$ <br />OFFICERIMEMBER EXCLUDED? <br />/ / <br />/ / <br />B yes, describe under <br />SPECIAL PROVISIONS below <br />E. L. DISEASE - POLICY LIMIT <br />$ <br />B <br />OTHER EMPLOYEE DISHONESTY <br />/ / <br />/ / <br />LIMITS $ 75, 000 <br />FORGERY/ALTERATION <br />CCP 0049129 04 <br />10/04/2004 <br />10/04/2005 <br />DESCRIPTION OF OPER nONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS, OFFICIALS, EMPLOYEES, AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED AS A <br />FUNDING SOURCE TO THE INSURED. FORM CG 2026 APPLIES. <br />CITY OF SANTA ANA/CDBG <br />COMM.DEV.AGY./L.FLORES <br />P.O. BOX 1988 M-25 <br />SANTA ANA CA <br />ACORD 25 (2001108 <br />{$,,;- INS025(0108).05 <br />14) 647-6549 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL YNDI*YAXXU MAIL <br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, MYM) <br />%�a�IXDa�iXuaD�s>�wucacu�clXnasi{gacxa�>3ut{a�i�rarfxiixxxaxrfx.�wa�:ifx�lXx`�ofx- <br />14NNXit1QNiC-0(Xdi?{iflt Y, <br />92702- <br />ELECTRONIC LASER FORMS, INC. - <br />© ACORD CORPOR <br />