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<br />A~ORD_ CERTIFICATE OF LIABILITY INSURANC~tJih I DATE (MMIDOIYY)
<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 Div of Hilb,Rogal & Hamil ton 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:909-88S-810S INSURERS AFFORDING COVERAGE
<br />INSURED INSURER A: Philadelphia Insurance Co.
<br /> tNSURER B: Preferred Emnlovers Insurance
<br /> Inland Mediation Board, Inc Markel Underwriters & Brokers
<br /> Attn: Betty Davidow INSURER c:
<br /> 1005 Begon1a INSURER 0:
<br /> Ontario CA 91762
<br /> , INSURER E;
<br />
<br />COVERAGES
<br />
<br /> THE POLICIES OF INSURANCE LISTED BELOW HoWE 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 POUCIES 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 />'LfR TYPE OF INSURANCE POLICY NUMBER DATE MM/OoNYl't DATE MMloo,rirN LIMITS
<br /> ~NERAl UABIUTY EACH OCCURRENCE ['1,000,000
<br />A X COMMERCIAL GENERAL LIABilITY PHPK021661 05/12/02 05/12/03 FIRE DAMAGE (Anyone fire) '100,000
<br /> I CLAIMS MADE [!J OCCUR MED EXP (Anyone person) . 5,000
<br /> X Hired/NOA PERSONAl & ADV INJURY .1,000,000
<br /> GENERAL AGGREGATE .3,000,000
<br /> GEN'L AGGREGATE LIMIT APnS PER: PRODUCTS - COMP/OP AGG s3,000,000
<br /> II (nPRD-
<br /> POliCY JECT LOG
<br /> AUTOMOSlLE U,4.BllITY COMBINED SINGLE LIMIT
<br /> - 51,000,000
<br />A ANY AUTO PHPK021661 05/12/02 05/12/03 (Eaaccident)
<br />-
<br /> ~ ALL OWNED AUTOS BODILY INJURY
<br /> (Per person) ,
<br /> SCHEDULED AUTOS
<br /> -
<br /> ~ HIRED AUTOS BODILY INJURY
<br /> (Per accident) ,
<br /> ~ NON..()WNED AUTOS
<br /> PROPERTY DAMAGE ,
<br /> This certifiClle 10 IaaeoI (Per accident)
<br /> ~~Ge UABIUTY Inronnahon olily and cOldi ra 110 ...... AUTO ONLY - EA ACCIDENT ,
<br /> ANY AUlO upon tho cortifiClle holder. ="!'I' EAA.CC ,
<br /> certificate ~ not IllIOIId, OTHER THAN
<br /> AUTO ONLY: AGG ,
<br /> EXCESS UABllITY mOllliOlllld. EACH OCCURRENCE .
<br /> ~ OCCUR D CLAIMS MADE AGGREGATE ,
<br /> ,
<br /> =i ~EDUCTIBLE ,
<br /> RETENTION , .
<br /> WORKERS COMPENSATION AND X I 'fcrR~'D~YTS I IVER-
<br />B EMPLOYERS' LI,4.BIUTY WKNI0248S3 06/22/02 06/22/03 E.l. EACH ACCIDENT , 1000000
<br /> E.L DISEASE. EA EMPLOYEE .1000000
<br /> E.l. DISEASE - POLICY LIMIT , 1000000
<br /> OTHER
<br />C Professional Liab PHSDO 2 77 0 3 05/15/02 05/15/03 Per Claim $1,000,000
<br /> DED$1000 PER CLAIM Aaareaate $1,000,000
<br />DESCRlPll0N Of OPERA 110NSflOCAll0NSNEHlCLESlEXCLUSIONS ADDED BY ENDORSEMENTfSPECIAL PROVISIONS
<br />*Except 10 day notice for non payment of premium. Verification of AP'P-lI~l'::D
<br />rvsd cert dt 8/14, per preferred policy term carr.
<br /> .- N
<br />~ERTIFICATE HOLDER I N I ADDITIONAL INSURED; 1~..sYR~f{ ~f2R: CANCELLATION ,,,. .,
<br /> ..~~ C.IT~S SHOULD ANY o~ THE ABOVE DESCRIBED POLICIES BE CANCELLED BEfORE THE EXPIRATION
<br /> .....DATE TH~E6F. THE ISSUING INSURER WILL Eo,u,........n.m rV MAIL ~ DAYS WRITTEN
<br /> City of Santa Ana ~l" . ~ NgJ"JC€TOTHE CERTIFICATE HOLDER NAMED TO THE LEFJ. 6~. ..__ ... I" un..... ,___I L
<br /> ,. ,,/
<br /> . ,
<br /> Rebecca Leiskes " '-. \ /tMr:ose IIi ~ '-ATln&.! no 114I:''''TV Qr ..tlY K1~'n IIn,....' Tll[ IflSI:fRCR, 11"[ A~"~~:l OR
<br /> 20 Civic Center Plaza \ /
<br /> P.O. Box 1988
<br /> Santa Ana CA 92702 ,::P -- " =z.~.,..,.~_
<br /> Linda Burns
<br />,CORD 25- 7/97 (._,.,,r.l @AC<1RDCOFl'PORATION1988
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