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<br />PCT-1,7-2002 16:20 THE CAMBODIAN FAMILY <br />ACOf:D.. CERTIFIV t:. Ut' LIAtslLl1 T <br /> <br />PROOU ER. (1i26) 599-8830 AX (626)599-8831 <br />Pacific General Insurance Services <br />405 E. Santa Clara Street <br />Suite 100 <br />Arcadia, CA 91006 <br />INSURED T e Ca nn Fam1 y <br />1111 E. Wakeham Avenue <br />Su He E <br />Santa Ana, CA 92705 <br /> <br />r I'", <br />'-~rr <br />/~ 714 <br />11'1'" "'-." '" c. <br /> <br />\--,-1mrJ- -II~- 07 <br />571 1974v P.M/04 . <br />03/11/2002 <br /> <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORCED BY THE POUCIES BELOW. <br /> <br />INSURER A: <br />INSURER B: <br /> <br />INSURERS AFFORDING COVERAGE <br />philadelphia Indemnity Ins. Co <br /> <br />INSURER c: <br /> <br />INSURER 0: <br /> <br />INSURER., Revised as of 09/11/02 <br /> <br />THE POliCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING <br />#lY REQUIREMENT. TERM OR CONDITION OF #lY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN. THE INSURANCEAFfORCEO BYTIEf'OLIClES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDmONS OF SUCH <br />POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .. <br />~ TYPE OF INSURANce POLICY NUMBER DATE (MMIDONVr DATE MMI~' UMIT5 <br /> ~NS.RAL LIABiliTY "HPK020993 03/09/2002 03/09/2003 EACH OCCURRENCE S 1. 000 . OO( <br /> X COMMEA.CIAL GENeRAl-LIABIliTY FIRE OAMAGE (An)' 0l11ll lire) S 100 OOC <br /> l CLAIMS MADE ill OCCUR MEO E.XP (Anyone person) S 5.00l <br />A PERSONAL & ADV lNJUFl,Y S 1 DOO 00l <br />'- <br /> I- GENiERALAGGREGATE S 3,000,004 <br /> GEmAGGFtEGATE LIMIT APPlll::S PEA.: PRODUCTS~COMP~PAGG S 1. 000 ooe <br /> n POl.ICY n 7e-tr n LOC <br /> ~MO.'L' UAIIIUTY HPK020993 03/09/2002 03/09/2003 COMBINED sINGLE LIMIT S <br /> ~V AUTO (EallcCidel\t) 1 000,00< <br /> I-- <br /> ~ AU. OWNED AUTOS BeOIL Y INJURY S <br /> SCHEDULED AUTOS ~fJ)erson) <br />A ...;.;.. <br /> ~ HIRED AUTOS BOOIL Y INJURV S <br /> ..!. NON-QWNEO AUTOS (perac:dc1entt <br /> PROPERTY DAMAGE S <br /> (Pel'ac:ckh!Hll.J <br /> RO' UAIIIUTI AUTO ONLY - EA ACCIDENT S <br /> ANY AUTO OTHER THAN EA ACe $ <br /> AUTO ONLY; AGO S <br /> EXCESS UABILITY EACH OCCURReNCE s <br /> b OCCUR 0 CLAIMS MAOE AGGREGATE S <br /> S <br /> rl ~OUCTI.LE S <br /> RETENTION S , <br /> WORKERS COMPENSATION AND 1 TORV LIMITS 1 I' E. <br /> EMPLOYERS LlAB1LllY E.L. EACH ACCIDENT , <br /> E.L. DISEASE. EA EMPLOVEf S <br /> EL aISEASE. POLICY LIMIT S <br /> OTHER "HPK020993 03/09/2002 03/09/2003 STA & 500/1000 comp/coll Deduc <br />A uta physical Damage PHPK020993 03/09/2002 03/09/2003 $121,000 & 500 Deductible <br />uS Pers Prop/Prof <br /> i abi 1 "HPK020993 03/09/2002 03/09/2003 $1.000,000 <br />DESCRIPTION OF _?p~RAlIONSI~~!IONSI\/ H~~EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS APPROVl::D AS'iO fORlY] <br />~CHEOULE OF VEHICLES & DRIVERS: ON FILE <br />I-ERTIFICATE HO:ER_I: NAMED ADOmON~L_IN.SUREO PER EXHIBIT G ATTACHED';j}h~_:i,!: <br />~'_'-<--'-"--- ... .. __._ .... .. _ __'_'___ __ ,__.' .AallIc\. SI1Cc<:ly <br />r. TEN DAY N.O.C. SIIALl BE GIVEN IN THE EVENT OF NON-PAYMENT OF PREMtilM. Deputy City Attorney . - ". <br />CEllTIF1CATE HOlOl:R ~ X I ADDIT\ONAL INSURED; INSURER LeneR: A CANCEL..... , 'u" <br /> SHOULD ~y OF THE ABOVE O!SCRlBe:D pouaes BE CANC!:UEO BEfORE THE I <br /> exPIRATION DATI! THEREOF, THE ISSUING COMPANV WILL~ MAIL <br /> City of Santa Ana -30- OAYS WRITTEN NOllCE TO THE CERTIFICATE HOLDER HAMEDTC THE LEFT. I <br /> Its' Officers, Agents. Employees ~KXdg3t9( I <br /> COGB M-34 <br /> P.O. Box 1988 ~~....wnxxxxxxxx <br /> Santa Ana, CA 92702 AUTHORIZED REPRES!NTA~ . Ju~ <br /> Michae' Martln ~ <br /> "'''' IllV7J IOU,," .. <br /> <br />E ES <br />