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<br />,ACORD. CERTIFICATE OF LIABILITY INSURANC~~~l DATE (MM/DOIYY)
<br /> '- 08/29/02
<br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />North. American Ins Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />A Divof Hilb,Rogal & Hamilton HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />P.O. Box 620 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />San Bernardino CA 92402
<br />Phone: 909-888-1321 Fax:909-885-8105 INSURERS AFFORDING COVERAGE
<br />iNSURED INSURER A: Philadelphia Insurance CO.
<br /> INSURER B: Preferred Employers Insurance
<br /> Inland Mediation Board, Inc INSURER c: Markel Underwriters & Brokers
<br /> Attn: Betty Davidow
<br /> 1005 Begonl.a INSURER 0:
<br /> Ontario CA 91762
<br />, INSURER E;
<br />
<br />COVERAGES
<br />
<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 /> lti"~ --
<br /> TYPE OF INSURANCE POUCV NUMBER DATEIUM/ODl'ri'iM OATEfMM/DDIYY WillITS
<br /> GENERAL L1ABIUTY EACH OCCURRENCE " 1.000,000
<br /> -
<br /> A X COMMERCIAL GENERAL LIABILITY PHPK021661 05/12/02 05/12/03 FIRE DAMAGE (Anyone fire) '100,000
<br /> ! CLAIMS MADE [!] OCCUR MED EXP (Anyone person) '5,000
<br /> X Hired/NOA PERSONAL & ADV INJURY , 1,000,000
<br /> GENERAL AGGREGATE , 3,000,000
<br /> ~~ AGG~EnE ~:: APnS PER: PRODUCTS - COMP/OP AGG 53,000,000
<br /> POLICY JECT LOC
<br /> AUTOMOBILE LlABIUTY COMBINED SINGLE LIMIT
<br /> - 51,000,000
<br /> A ANY AUTO PHPK021661 05/12/02 05/12/03 (Ea accident)
<br /> -
<br /> ALL OINNED AUTOS BOOIL Y INJURY
<br /> - ,
<br /> SCHEDULED AUTOS (Perpersorl)
<br /> -
<br /> ~ HIRED AUTOS BODILY INJURY
<br /> (Peraccidarlt) ,
<br /> ~ NON-QWNED AUTOS
<br /> PROPERTY DAMAGE ,
<br /> This certificate Illnaed a I. (Peraccideht)
<br /> GARAGE L1ABIUTY mlOnnalton only lIIld_fi ;:..... AUTO ONLY - EA ACCIDENT ,
<br /> ~ ANY AUTO upon the certificate boldet. EA Ace ,
<br /> certificate cIoet DOt amend, ....., OTHER THAN
<br /> AUTO ONLY: AGG ,
<br /> EXCESS L1ABellTY mentioDod. EACH OCCURRENCE ,
<br /> :::~rOCCUR 0 CLAIMS MADE AGGREGATE I
<br /> I
<br />, ==i ~EDUCTI8LE ,
<br />,
<br />, RETENTION , ,
<br />, WORKERS COMPENSA nON AND X I fci'R~'~~~TSI lu~:t
<br /> B EMPLOYERS' UABeLlTY WKN1024853 06/22/02 06/22/03 , 1000000
<br /> E.l. EACH ACCIDENT
<br /> E.L DISEASE - EA EMPLOYE , 1000000
<br /> E.l. DISEASE. POLICY LIMIT , 1000000
<br /> OTHER
<br /> C Professional Liab PHSD027703 05/15/02 05/15/03 Per Claim $1,000,000
<br /> DED$1000 PER CLAIM Aqqreqate $1,000,000
<br /> DESCRIPTION OF OPERATlONSIlOCATlONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVJSIONS
<br /> *Except 10 day notice for non payment of premium. Verification of ,~l"PR:l9'I'ED
<br /> rvsd cert dt 8/14, per preferred policy term corr.
<br /> ~,.
<br /> CERTIFICATE HOLDER I N I ADDITIONAL INSURED; IN)lURE~'~YR; CANCELLATION 'J ".....,,,
<br /> ~~~~~~~S SHOU_LD' ANY;: THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br /> o.UE~ F,THElSSUlNG1N5URERWllLFIIlIn MAIL 30 QAYSWRlTTEN
<br /> City of /' .
<br /> Santa Ana ~ n, ~~CE TO THE CERTlFICATE HOLDER NAMED TO THE LEFT, tnIl t"....~uJtif' T ~ -..
<br /> Rebecca Leiskes \' \' ./'
<br /> 20 Civic Plaza , , ./ ,un u",
<br /> Center
<br /> P.O. Box 1988 , .~ ,~..........
<br /> Santa Ana CA 92702 ~ -,-, -1':;'-,.__,
<br /> I Linda Burns
<br /> \CORD 25,S 7/97 '....r~'/ @AC D'CORPORATlON 1988
<br />
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