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DATE (MMIDDIYYYY) <br />Aco-Ta CERTIFICATr' 7F LIABILITY INSURANC - TEENCH M 07/28/05 <br />Advanced Insurance Marketing <br />P.O. Box 4459 <br />Orange CA 92863-4459 <br />Phone:714-997-8100 <br />INSURED <br />Teen Challenge of So. Ca. Inc. <br />Sandy Segrest <br />5445 Chicago Avenue <br />Riverside CA 92507 <br />COVERAGES <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 NAIC # <br />INSURER A- Philadelphia Indemnity Ins co. <br />USURER B: <br />INSURER C. <br />INSURER D'. <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 />I <br />LTR <br />NSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />DATE IMM/DD <br />POLICY <br />DATE MM/DO/Yl' <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />ATED—— <br />DPREANMISESGETDR(Ea occurence) <br />E300,000_ , <br />A <br />i <br />X COMMERCIAL GENERAL LIABILITY <br />PHPK130052 <br />07/19/0$ <br />07/19/06 <br />MED EXP(Any one pars.,) <br />( CLAIMS MADE , OCCUR <br />$ 15, 000 <br />PERSONAL 8 ADV INJURY <br />$ 1 , OOO , OOO <br />GENERALAGGREGATE <br />s2,000,000 <br />GENL AGGREGATE LIMIT APPLIES PER. <br />PRODUCTS - COMP/OP AGG <br />$2,000,000 <br />X POLICY PECOT LOC <br />Em Ben. <br />1,000,000 <br />AUTOMOBILE LIABILITY <br />� <br />COMBINED SINGLE LIMB <br />$1,000, 000 <br />A <br />I$iANY AUTO <br />PHPK130052 <br />07/19/05 <br />07/19/06 <br />(Ea accident) <br />p <br />ALL OWNED AUTOS <br />BODILY INJURY <br />$ <br />SCHEDULED AUTOS <br />(Per person) <br />HIRED AUTOS <br />BODILY <br />$ <br />NON OWNED AUTOS <br />(Per accidcitlenU <br />ao t) <br />PROPERTY DAMAGE <br />- -- ----- <br />$ <br />(Per accident) <br />RAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT <br />$ <br />ANY AUTO <br />OTHEEAACC <br />$ _ _— <br />P <br />AUTO ONLY <br />AUTOONLY'. AGO <br />$ <br />ESSIUMBRELLA LIABILITY <br />EACH OCCURRENCE <br />$9,000,000 <br />A <br />OCCUR f CLAIMS MADE <br />PHUB048953 <br />07/19/05 <br />07/19/06 <br />AGGREGATE <br />$ <br />DEDUCTIBLE <br />$ <br />X RETENTION $ 10 , 000 <br />$ <br />WORKERS COMPENSATION AND <br />TORY LIMITS Eft <br />EMPLOYERS' LIABILITY <br />---- — <br />— — <br />C.L. EACH ACCIDENT <br />ANY PROPRIETORAPARTNERIEXECUTIVE <br />AbO <br />F <br />Fr� <br />_-. A� <br />$ <br />OFFICER/MEMBER FxClUDED' <br />Al <br />EL. DISEASE EA EMPLOYEE <br />$ <br />I( yes, describe under <br />SPECIAL PROVISIONS below <br />E IFDISEASE - POLICY LIMIT <br />$ <br />OTHER <br />L <br />ain Smt Shea <br />y <br />Assistant <br />City <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISI NS <br />10 day notice of cancellation for non-payment of premium. City of Santa Ana, <br />its officers, agents, employees and volunteers are named as Additional <br />Insured as respects their interests and connection with the named insured. <br />RE: Funding <br />City of Santa Ana CDBG M-25 <br />Community Development Agency <br />P.O. Box 1988 M-25 <br />Santa Ana, CA 92702 <br />CITSAN•1' I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILLlNBMYWiiO MAIL 30 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />ACORD 25 (2001108) <br />rr•�.oraeni <br />