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<br />I
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<br />ACORQ CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDNYYY)
<br />02/08/2006
<br />PRooueER (714)838-1912 FAX (714)838-7568 THIS CERTIFICA TE IS ISSUED AS A MA TTER OF INFORMATION
<br />Lake Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA TE
<br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />13891 Newport Ave., Suite 285 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Lic #0747473
<br />Tustin, CA 92780 INSURERS AFFORDING COVERAGE NAIC#
<br />INSURED Cambodian Family ,4-~[)()'f- ~3 INSURER A Philadelphia Ind. Ins. Co.
<br /> 1111 East Wakeham Avenue 4- ;;I{XJ4-;).03- DI INSURER 8:
<br /> Suite E A-;;.ro5 -D18- rx:4> INSURER C
<br /> Santa Ana, CA 92705 A-.;>.a:>5- liN INSURER 0
<br /> ..
<br /> INSURER E
<br />
<br />THE POLlClES OF INSURANCE LISTED BELQWHAVE 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 />II~~~ ~'1:CJ:r TYPE OF INSURANCE POLlCY NUMBER POL-ICY EFFECTIVE POLlCY EXPIRATION LIMITS
<br /> ~NERAL LIABILITY PHPK155246 03/09/2006 03/09/2007 ~~_?CC~RRENCE , 1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED , 400,000
<br /> ~ ~ CLAIMS MADE [!] OCCUR MEO EXP (Anyone person) , 5,000
<br />A - PERSONAL & ADV INJURY , 1,000,000
<br /> GENERAL AGGREGATE , 3,000,000
<br /> ~.
<br /> GEN'!... AGGREGATE UMIT APr~Y PER PRODUCTS. COMP/OP AGG , 1,000,000
<br /> h ,hPRo.
<br /> POLICY JECT lOC
<br /> AUTOMOBILE LIABILITY PHPK155246 03/09/2006 03/09/2007 COMBINED SINGLE LIMIT
<br /> -.. ,
<br /> ANY AUTO (Eaacddent) 1,000,000
<br /> f.-
<br /> All OWNED AUTOS BODilY INJURY
<br /> f.- ,
<br /> SCHEDULED AUTOS (Per person)
<br />A X
<br /> HIRED AUTOS 800ll Y INJURY
<br /> X ,
<br /> NON-OWNED AUTOS (Per accident}
<br /> X $0 Deductible PROPERTY DAMAGE
<br /> 2. (Peraccidenl) ,
<br /> ==i~GE LIABILITY AUTO ONLY. EA ACCIDENT ,
<br /> ANY AUTO OTHER THAN EA ACC ,
<br /> AUTO ONLY AGG ,
<br /> 3ESS1\lMBRELLA l.IABll.lTY /~ p;i' 1,,- EACH OCCURRENCE ,
<br /> OCCUR 0 CLAIMS MADE 0::<./"Lj AGGREGATE ,
<br /> .~ ,
<br /> ~
<br /> DEDUCTIBLE ,
<br /> RETENTION , ,
<br /> WORKERS COMPENSATION AND '1 ~5i~J~'<1 IOJ,t<.
<br /> EMPLOYERS' UABILlTY .-
<br /> ANY PROPRIETORfPARTNER/EXECUTIVE EL.. EACH ACCIDENT ,
<br /> OFFICER/MEMBER EXCLUDED? EL-_ DISEASE - EA EMPLOYE ,
<br /> It yes, describe under EL DISEASE - POLICY LIMIT
<br /> SPECIAL PROVISIONS below ,
<br /> ~HER . PHPK155246 03/09/2006 03/09/2007 $1,000,000 Each Claim
<br />A use & Molestatlon $1,000,000 Aggregate
<br /> $0 Deductible
<br />DESCRIPTION OF OPERA no~ I LOCATIONS I VEHICLES / EfLUSIONS I'DDED BY ENDON'EMENT I SPe:C~L PROVISJON\
<br />"Except 10 days or non payment 0 prem,um. E"1' oyee D,s onesty 200,000/$2,500 Oed.
<br />Professional Liability $1,000,000 Each Occ/$3,OOO,OOO Aggregate. City of Santa Ana
<br />'s named additional insured per contract with named insured. Schedule of vehicles
<br />nd drivers on file. "Non Profit organization"
<br />
<br />COVERAGES
<br />
<br />The City Of Santa Ana: Its Officers,Employees
<br />Agents, representatives
<br />20 Civic Center Plaza (101-30)
<br />Santa Ana, CA 92705
<br />
<br />CANCEL 11 N
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPlRA TtON DATE THEREOF, THE ISSUING IN$URER WILL r,)6(X~li MAlI..
<br />30.... DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT
<br />llIXOO(l(~JOOOO(~ltKllMO(lW<Il~X~XX:
<br />XJll VM<<XXXXXXXX
<br />
<br />CERTIFICATE HOLDER
<br />
<br />ACORD 25 (2001/08) FAX: (714)571-1974
<br />
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<br />@ACORDCORPORATION 1988
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