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SEPit BY: LAKE SNSURANCE AGENCY; 7148387568; SEP-B-nF 10:11 AM; PAGE 1/2 <br />~BL~„ CERTIFICATE OF LIABILITY INSURANCE o9ioz~2oo5 <br />FROONCER (714)E38-1912 FAX (714) i38-7568 <br />Lake Insurance Agency <br /> <br />13891 Newport Ave. , Suite 285 THIS CERTIFICATE IS ISSUED AB AMATTER OF NtfORMATR7N <br />ONLY AND COMPERE NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Lic 10747473 <br />CA 927b0 <br />Tustin <br />DINOCOVERAGE <br />1NSURERSAFFOR <br />NAIC1 <br />, <br />N$URED Orange County dren's Therapeutic Art Cente ~,I <br />INSURER A: ChaiY~kleStern Heritage Ins. Co , <br />208 North Broadway tr+sulD:R e: <br />Santa Ana, CA 92701 IN5U~R G: - <br /> INSURER D _ <br /> N$URER E: <br />!`l~VFQAf.FR <br />THE POLICIES QF INSURANCE USTED BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE Pvucr rewuu rnulr~n~ cu. •.~, ••„ ~~ ~..,.~.~•~ <br />TERM OR GONDInON OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TD YYHICH THIS CERTIFICATE MAYBE ISSUED OR <br />T <br />, <br />ANY REQUIREMEN <br />ED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL 7F1E TERMS. EXCLUSIONS AND GONDIT10Na OF SUCH <br />R <br />D <br />MAY PERTAIN, lME INSURANCE AFFO <br />POLICIES. AGGREGATE LIMTTS SNONM MAY HAVE BEEN REDUCED BY PAID CLAIMS. , , , <br />~ <br />~ TYPE OF IN$LmANCE POLICY NUNBmI POLIC'f EFFECIIYE l1WRATgN 1aa1 7 <br /> DENSRAL wailTY SCPD573t31 08/02/2005 08/02/2006 EACH occuRRENGE s 1 ODD <br /> ~ CDNMERCIAL GENERLL LIABILRY DAMAGE TO RENIED <br />SES iF i _SO <br /> , CLNMS MADE ~ CCLLR MED EXP (Arv/ aN DElim) i _ S OO <br />A PERSONALaADV INJURY i 1 OOO OO <br /> <br /> GENERAL AOOREOATE 3 21 DOD, DO <br /> <br /> GE NL AGGREWTE UMRAPPLJE9 PER- PRODUCTS-COMP/OP AGG x Include <br /> PDUCr _ ~~ LOC <br /> AUT OMOBILE IMBILffY COMBINED SINGLE LINK S <br /> - IEe eiPxNnl <br /> ANYAUfO -~- <br /> ,.... <br /> ALLW+NEDAUTO$ BODILY INJURY S <br /> <br />SCHEDULED AUIOti (hrPNEPn) <br /> <br /> HIRED AVTDS BODILY N,JURV S <br /> <br />NON-0WHEO AUTOS IFar acdda+) <br /> <br /> PROPERTY DAMAGE i <br /> --- , IPx awlwRl <br /> fTY AUTO ONLY-EA ACCIDENT 7 <br />,,.,.. <br /> GA RAGE LMYL EA ACC <br />R TNAN <br />GTHF _ <br />! <br /> ANY AUTO . <br />. <br />AU700NLY. AGG 5. .._ <br /> BIELL4l11BILR1• EACH OCCURRENCE S <br /> E%CF59NN <br />R ~CLMMS MAC <br />OLGI AGGREGATE 1 _ <br /> . f <br />_.. <br /> I i <br />'- <br /> CTIBLE <br />OEDL C4S ~ ~ rv~g~l f <br /> RETENTION $ , V1C STATLL 0714 <br /> PENSATION AND <br />CO <br /> WORKER! <br />M <br /> pIMAYER$'WNOTY E.L. EACH ACCIDENT S <br /> ANY PROPRIETOR~PMTNERIFXECVTIVE <br />OFFICERIMEMeER EXClUDE07 <br />~ ~ <br />, <br />_ <br />edy <br />E.L. DEiEASE-EA EMPLOYE <br />d <br /> R w aRaeR UNr S <br />Laura Sti e E.L. DISEASE • POLICY OMIT S <br /> SPECIAL PROVISIONS CNOR <br />OTNER A. >lSiaa <br />mDN OP OPEMTIDN$! LOCATIONS I VEXL7.E$ l E1fCWNDM$ADDED BY ENOpRCEMENr1 VEtlAL MD <br />~yPoOf Santa Bna is Mamed as additiwial insured per FDrm attar Original Signed form attached <br />T <br />Subject to 30 days notice of cancellation for non-payBlent of premiwn. <br />THE CITY OF SANTA ANA <br />Community Development Agency <br />Attn: Frank Hernando <br />PO 8071 1988 <br />Santa Ana, CA 92702 <br />• PlN01N 7i I9AM MRl FAX: <br />Sm7MD ANY OF THE ABOVE pE$CR16ED POLN:IPE BE CANCELLED aEFORE THE <br />EXPmATION PATE THERE, THE 168UING INSURER WILL 71o9D(ibE186 W11L <br />30 DAYS wRlTTlN NOTICE 70 TTE CENIIFICATE HOLDER IUMEO TG THE LEFT. <br />XX <br />CORPORATION 1888 <br />/~ _ 4. .l /. /~~ . <br />