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ACORpM CERTIFICATE 7F LIABILITY INSURAN'~' oaiisi2 0 ) <br />PRODUCER (310) 393-9477 FAX (31.,~ 393-7186 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />White & Company Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />p 0 Box 70 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Santa Monica, CA 90406-0070 <br />INSURED women~S Irdn5lil <br />PO Box 6103 <br />Orange, CA 92863 <br />INSURERS AFFORDING COVERAGE NAIC # <br />wsuRER A: Philadelphia Ins Co <br />INSURER a <br />INSURER G. <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 <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT W ITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 />INSR DD' rypE OF INSURANCE POLICY NUMBER POLICY EFFECTNE POLICY EXPIRATION LIMRS <br /> GENERAL LIABILITY PHPK115 560 04/04/2005 04/04/2006 EACH OCCURRENCE E 1,000rOQ <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S LOO,OO <br /> CLAIMS MADE X^OCCUR MED EXP (Any one persanl $ S,OO <br />A PERSONAL & ADV INJURY E I , OOO.OO <br /> GENERAL AGGREGATE $ 2,000,0 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,00 <br /> POLICY JECOT LOC <br /> AUT OMOBILE LIABILITY PHPK115560 04/04/2005 04/04/2006 COMBINED SINGLE LIMIT <br /> X ANV AUTO (Ea acclaenl) $ 1, 000 , 00 <br /> ALL OWNED AUTOS BODILY INJURY <br />$ <br /> SCHEDULED AUTOS (Per person) <br />A <br /> HIRED AUTOS 80DILY INJURY <br />$ <br /> NON-OWNED AUTOS (Per accitlenl) <br /> PROPERTY DAMAGE S <br /> (Per accitlenl) <br /> GAR AGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACG $ <br /> AUTO ONLY. qGG $ <br /> EXCESSIUMBRELLA LIABILRY PHUB043582 04/04/2005 04/04/2006 EACH OCCURRENCE E 2,000,00 <br /> X OCCUR ~CLAIMSMADE AGGREGATE $ 2,000,00 <br />A $ <br /> DEDUCTIBLE $ <br /> RETENTION $ - $ <br /> WC STATU- OTH- <br /> WORKERS COMPENSATION AND <br /> EMPLOYERS' LIABILITY <br /> <br />E <br />ECU <br />E.L. EACH ACCIDENT <br />$ <br /> ANY PROPRIETOR/PARTNERIEX <br />TIV <br />OFFICER/MEMBER EXCLUDED? EL. DISEASE-EA EMPLOYE $ <br /> If yes, describe untler <br />SPECIAL PROVISIONS below aura SC1CC S}1D dy E.L. DISEASE-POLICY LIMIT $ <br /> OTHER ASS SCaDC c1Cy ALt TnCV <br />ESCRIPTION OP OPERATIONS /LOGANONS /VEHICLES / EX0.DSIUNS ADUtU 8Y tNUUIW tfptN/ / JYtIAAI YnWI51UNS <br />ity of Santa Ana, its officers, agents, employees, and volunteers are additional insureds as per form <br />C-NP-003 (OS/O1) Item M -Funding Source and Primary Insurance as per form 0000 O1 07 98, both <br />ttached to the general liability policy and accompanying this certificate. <br />''°Except for 10 days written notice of cancellation for non-payment of premium. <br />City of Santa Ana - CDBG M-25 <br />Attn: Frank Hernandez <br />P, O. Box 1988 M-25 <br />Santa Ana. CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL XITH(2XfX1 MAIL <br />3O* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />D(Jidt161C1(8(aXdbW G%~YrkJIXMtiI'D@~l'aXIXXYr)(J~YNd(KKIXdG~`Oh14X9€XA6M114Yi(XX <br />AUTHORIZED REPRESENTATIVE <br />CORD 25 (200'1 /08) FAX: (714)647-6549 <br />©ACORD CORPORATION "1989 <br />