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<br />~ OCl\'17-2002 16: 20 THE CAMBODIAN FAMILY <br />ACORD CERTIFr..;' - It: Ut' LIAtslLl1 , <br />.. <br />PROD ER (6Z6)599-8830 (6Z6)599-8831 <br />Pacific General Insurance Services <br />405 E. Santa Clara Street <br />Suite 100 <br />Arcadia, CA 91006 <br />I'SUREO T e Ca un Fa y <br />1111 E. Wakeham Avenue <br />Suite E <br />Santa Ana, CA 9Z705 <br /> <br />r '_' -- <: W 1\ <br />r- <br />,,~ 714 571 <br />1NV' ""-'''''1:; <br /> <br />1974 <br /> <br />P.03/04 <br />03/11/Z00Z <br /> <br />ONLY AND CONFERS NO RIGHTS UPON lllE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER lllE COVERAGE AFFORDED BY THE POUCIES BELOW. <br /> <br />_\0 <br />01>1- <br />,,'1, <br /> <br />INSURER A: <br /> <br />INSURERS AFFORDING COVERAGE <br />Philadelphia Indemnity Ins. Co <br /> <br />011 <br /> <br />INSUREFt B: <br /> <br />INSURER c: <br />INSURER 0: <br /> <br />INSURERE: Revised as of 09/11/0Z <br /> <br /> <br />s <br /> <br />THE puuClES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVe FOR THE POLICY PeRIOD INDICATED. NOTWITtiSTANDING <br />1#f REQUIREMENT. TERM OR CONDITION OF PI>IY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN. THE lNSUFlANCE.AFfOllOSD BY THEf'OlIClES QESCRIBED HEREIN IS SUBJECT TO AlL THE TERMS, EXCLUSIONS PI>ID CONDmONS OF SUCH <br />POUCIES. AGGREGA.TI: LIMITS SHOWN MAY HAVE BeeN REDUCED BY PAID CLAIMS. <br />IrrG TYPEOPINSURANCE POUCYNUMBER rr.t-J.'E~ DATE.fMMIDDNY) <br />OENERALLIABILlTY PHPKOZ0993 03/09/2002 03/09/2003 EACHOCCURRE/<CE <br />~ <br />X COMMERCIAl GENERAl. LIABILITY <br />I CLAIMS MADE ill OCCUR <br /> <br />LIMITS <br /> <br />GEN'L.AGGRE~ LIMIT APP~SPER: <br />I POliCY I I 7& I I LOC <br />AUTO..OBILE UAlIIUTY PHPK020993 <br />- AN. AUTO <br />- <br />ALL OWNED AUTOS <br />..,.,- <br />X SCHEOUI.l:O AUTOS <br />A-,- <br />X HIRED AUTOS <br />X NON-DWNEO AUTOS <br />..:.:. <br />- <br /> <br />$ <br />F~RE OAMAGE (An)' 0I'l' fife) $ <br />MeDEX.P(Anyon.~on) S <br />PERSONAL & /JJV INJURY $ <br />$ <br />$ <br /> <br />1.000.00~ <br />100 00li <br />5.00~ <br />1 000 000 <br />3 000 Onii <br />1.000.00~ <br /> <br />A <br /> <br />Ge~RAI.. AGGREGATE <br />PROCUCTS.COMP~PAGG <br /> <br />03/09/2002 03/09/Z003 <br /> <br />COMBINED SINGI.E LIMIT <br />(EalilcCiden.l) <br /> <br />s <br /> <br />1 000 OOC <br /> <br />BOon. Y lNJURv <br />(per person) <br /> <br />s <br /> <br />BOOIL Y INJURV <br />{per aCCIdent} <br /> <br />s <br /> <br />PROPERTY DAMAGE <br />(Perac:c:klel1l) <br /> <br />s <br /> <br />~GE L1ABIUTY <br />I ANY AUTO <br /> <br />EXCESS UABIU'TY <br />b OCCUR 0 ClA1MS MADE <br /> <br />-, DEDUCTIBLE <br />I RETENTION S <br />WORKERS COMPENSA110N AND <br />EMPLOYERS' L.IABILlTY <br /> <br />. . <br /> <br />AUTO ONt Y - EA ACCIDENT S <br />EA Ace $ <br /> <br />OTHER THAN <br />AUTO ONLY: <br /> <br />EACH OCCURRENCE <br />AGGREGATE <br /> <br />Aoo S <br />S <br />S <br />S <br />S <br />S <br /> <br />IrORV LIMITS I IU.I.- <br />E.L. EActf ACCIDENT S <br />E.L DISEASE. EA EMPLOVEE $ <br />E.L. DISEASE. POLlCV LIMIT S <br /> <br />OTHER PHPKOZ0993 03/09/2002 03/09/2003 <br />A ~uto physical Damage PHPKOZ0993 03/09/Z002 03/09/2003 <br />3US Pers Prop/Prof <br />iabil PHPK020993 03/09/2002 03/09/Z003 <br />D~.. RlPnuN 0' OPERAnONSIl. ICLUlEXCLUSlONlI..,DEO BY ENOORSE....HSPECIAL I'I<QVI..ONS . I' 0 \1 F'L') <br />CHEDULE OF VEHICLES /I, DRIVERS: ON FILE APi' , .~ <br />~ERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED PER EXHIBIT G ATTACHED';$'-fJ x_,Ll; <br /> <br />.. ___~__ _ _ __..._.._.'0'=""."'.'. " '"'__'''~''''''''' . "l'awa Sheedy <br />~ TEN DAY N.O.C. SHALL BE GIVfN IN lllE EVENT OF NON-PAYMENT OF PREMIUM. Depu,'y ('ily Attorney'. <br /> <br />c"KTlfICA TE HOLDER I X I AOomONAL INSURED; INSURER LETT'R, A CANcE....... ,"un <br />SHOULD ANY OF THE ABOVE DESCRIBED POUCU!S BE CANCELLED SEFQRI! THE <br />EXPIRATION DATI! THEREOF, THE ISSUING CQMPANV WILL ~ MAIL <br />--3.0- DAVS WRITTEN NOnCS TO THE CERnFICATI! HOLDER NAMED TO THE LEFT, <br /> <br />STA & 500/1000 comp/coll Deduc <br />$lZl,OOO /I, 500 Deductible <br />$1.000,000 <br />AS TO FORM <br /> <br />City of Santa Ana <br />Its' Officers, Agents /I, Employees <br />CDGB M-34 <br />P.O. Box 1988 <br />Santa Ana. CA 9Z70Z <br /> <br />Il~A""~ <br />A AT11f"_. . <br />Michael Mart1n -/ n~ /Vi. ~ <br /> <br />'I"'''' <br />