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<br /> ~ CERTIFICATE OF LIABILITY INSURANCE -, OA TE (MMIOOIYYYYJ
<br /> 02/08/2006
<br />PRooueER (714)838-1912 FAX (714)838-7568 THIS CERTIFICATE IS ISSUED AS A MA ITER OF INFORMATION
<br />Lake Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA TE
<br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />13891 Newport Ave., Suite 285 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Lic #0747473
<br />Tustin, CA 92780 INSURERS AFFORDING COVERAGE NAIC#
<br />INSURED Carmod1an Fami 1 y A-~oo'-l-~3 INSU~ER A Philadelphia Ind. Ins. Co,
<br /> 1111 East Wakeham Avenue 4- ;;ICJo4-~03- DI INSURER B:
<br /> Suite E f.,-;).(X)5 -D18- ~ INSURER C
<br /> Santa Ana, CA 92705 .4-';>'0::>5- /fi9 INSURER 0
<br /> -,
<br /> lNSURER E
<br /> G~.
<br />THE POLlCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAND!NG
<br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOC1JMENTWlTH RESPECT TO v.JHICH THIS CERTIFICATE MAY BE ISSUED OR
<br />MAY PERTAIN, THE INSURANCE AFF=ORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, eXCLUSIONS AND CONDITIONS OF SUCH
<br /> POLICIES. AGGREGATE LIMITS SHOVVN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR DO' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE p~%~J EXPlRA nON LIMITS
<br /> ~ENERAL L.IABILITY PHPK155246 03/09/2006 03/09/2007 EACH OCCURRENCE , 1,000,000
<br /> X COMMERCIAL GENERAL. LIABILITY ~AGIT6 RENTED , 400,000
<br /> - o CLAIMS MADE ~ OCCUR MEO EXP (Any ene person) , 5,000
<br />A - PERSONAL & AD" \NJUR'( , 1 000 000
<br /> -, GeNERAL AGGREGATE , 3.000,000
<br /> ~l AGG~~ttIMIT p.Pr~~t PER PRODUC1S - COMPIOP AGG , 1. 000 ,000
<br /> PRO-
<br /> POLICY JECT LOC
<br /> AUTOMOBILE \...lA8ILITY PHPK155246 03/09/2006 03/09/2007 COMBINED SINGLE LIMIT
<br /> --, ,
<br /> ANY AUTO (EilIaccJdent) 1,000,000
<br /> -
<br /> - ALL OWNED AUTOS BODILY INJURY
<br /> (Perper$On) ,
<br />A SCHEDULED AUTOS
<br /> ~ HIRED AUTOS BODILY INJURY
<br /> ,
<br /> ~ NON-Q\tVNEo AUTOS (Peraccidillnt)
<br /> ~, $0 Deductible PROPERT'( DAMAGE
<br /> (Peraccidenl) ,
<br /> ROElI.BllITY AUTO ONLY. EA ACCIDENT .
<br /> ANY AUTO OrHER THAN EA Ace .
<br /> AUTO ONLY AGG .
<br /> t=jE5SJ\JMBRELlA LlABtl.lTY 7~ ~ 1~2- EACH OCCURRENCE .
<br /> OCCUR D CLAIMS MADE ~~ , /1,/ AGGREGATE ,
<br /> '~ /~":.;_.,e.-('_
<br /> .
<br /> R ""DUC"BLE .
<br /> RETENTION . ,
<br /> WORKERS COMPENSATION AND ll'.'i.mJ~'<1 10!,(<'
<br /> EMPLOYERS' LIABILITY -
<br /> ANY PROPRIETORIPARTNERIEXECUTIVE E.L, EACH ACCIDENT ,
<br /> OFFICERIMEMBER EXCLUDED? EL. DISeASE _ EA. EMPLOYE .
<br /> ~~~~I~tS~~bO~~~ONS blll~ EL. DISEASE - POLICY LIMIT .
<br /> ~HER . PHPK155246 03/09/2.006 03/09/2007 $1,000,000 Each Claim
<br /> use & Molestatlon
<br />A $1,000,000 Aggregate
<br /> $0 Deductible
<br />DlSCRIPTION OF OPERA no~ I LOCA TlONS I VEHICI.ES I EYfLUSIONS I'DDED BY ENDO~EMENT I SPtC~L PROVISJON\
<br />. xcept 10 days or non payment 0 prem,um. Emp oyee D,s onesty 200,000/$2.,500 Oed.
<br />~rofessional Liability $1,000,000 Each Occ/$3,OOO,000 Aggregate. City of Santa Ana
<br />'s named additional insured per contract with named insured. Schedule of vehicles
<br />nd drivers on file. "Non Profit organization"
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<br />C TIFICA T
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<br />The City Of Santa Ana: Its Officers,Employees
<br />Agents, represen~a~ives
<br />20 Civic Center Plaza (M-30)
<br />Santa Ana, CA 92705
<br />
<br />SHQUI.D ANY OF THE ABOVE DESCRl8EO POLICIES Bl:: CANCELLED BEFORe THE
<br />EXPIRATION DATE THEREOF, THE ISSUING IN$URER WilL r,)6(X~li MAlI..
<br />30.... DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER HAMaJ TO THE LEFT
<br />1I\llM.1(~_J(I(<<X~lllililOOOOliX~XX:
<br />~XXXXXXXX
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<br />ACORD 25 (2001108) FAX: (714)571-1974
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<br />@ACORDCORPORATION 1988
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