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CERTIFICATE LIABILITY INSURANCE <br />CATE IMMIOUNYYYI <br />)OF7 <br />PRODUC RiZ <br />Lake insurance Agency <br />13891 Newport Ave . , Su i to 285 <br />S CERTIFICATE 12 ISSUED ASAMATTEROFINF0/01/I007 <br />I ON <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTE13THECOVERAGE AFFORDED BY THE POLICIES ELOW. <br />INSURERS AFFORDING COVERAGE <br />INSURERA Chaix/Western Heritage Ins. Co <br />NAIC Y <br />L i c #0747473 <br />Tustin, CA 92780 <br />1NWRED Orange County Chl I dren's Therapeutic <br />Art Center, Inc c� 6 _ 0 "cK /- D2 <br />2215 N. Broadway A -o <br />INSURER 6 - <br />WSURER D! <br />INSURERC <br />Santa Ana, CA 92706 A -o1OO b - �y_ol <br />INSURER E: <br />v <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. AOZ'diEGATE LIhNTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- _ <br />IN R TYPEOPRNSURANCE FOUCYNUMSER POLICY PF C EP9Y TpN L1MiB <br />GENERALLIAEIUTY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE O OCCUR <br />SCP0618374 <br />08/02/2007 <br />08/02/2008 <br />EACHOCCURRENCE <br />3 1,000,000 <br />TO <br />j��D <br />f rJ0 <br />NED EAP (Anyone pram) <br />3 5, <br />PERSONAL • ADV INJURY <br />3 1 , ODD , 0 <br />A <br />GENERAL AGGREGATE <br />3 21000.00( <br />GENL AGGREGATE LWaIITAPPUES PER <br />PRODUCTS •COMPIOP AGO <br />f 2,000. 00( <br />POUCY hCT LOC <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE OMIT <br />(EA.aitlwn) <br />$ <br />LY RQURY <br />f <br />- <br />ALLOWNEDAUTOS <br />SCHEDULED AUTOS <br />HIREOAUTOS <br />NONIWYNED AUTOS <br />A <br />1�� <br />O gO� <br />r <br />BO LYE INJURY <br />PROPERTY DAMAGE <br />3 <br />I E, <br />t�RCK ey <br />GARAGE LIAEUTY <br />AUTO ONLY . EA ACCIDENT <br />s <br />EAACC <br />OTHER THAN <br />AGO <br />i <br />ANY AUTO <br />ASS ,Start <br />3 <br />EXCEEBIUMBRELtA UABIUTT <br />EACH OCCURRENCE <br />3 <br />AGGREGATE <br />3 <br />OCCUR o CWbl MADE <br />- <br />3 <br />3 <br />DEDUCTIBLE <br />3 <br />RETENTION s <br />WORKERS COMpiNSATgR AND <br />IAC STATU- OTH• <br />EL EACH ACCIDENT <br />3 <br />EMPLOYERS' LIABILITY <br />ANY PROPIUETORIPARTNeK&AFCuriv <br />OFFFICERIMEMSER EXCLUDED? <br />CL D GEAW - EA EMPLOYE <br />i <br />E y _ PROM � S MIn+' <br />SP[�JAI <br />E.L. D18EAS6 - POLICY LIMIT I <br />f <br />B <br />e rectors b Officers <br />lability <br />PHSD259007 <br />08/07/2007 <br />08/07/2008 <br />Limit - $500,000 Policy Period <br />Limit - $500,000 Aggregate <br />DEECRJP ION OF OP TIONB! tQCATgNE l VENX:Ll3 EXCLUSIONS ADDED BY ENO BlMCNi f 31ECIAL ► 1 <br />rtltllcate molder Is Additional Insured as per 'Norm CG2026 �1 %805 Primary bNon-Contributory <br />rding applies as per form WH1200106 (03/99) <br />10 days for non-payment of premium <br />THE CITY OF SANTA ANA <br />Attn: Frank Hernandez <br />PO sax 1988 <br />Santa Ana, CA 92702 <br />Arnwn251200TroR► FAX: (714)647-6549 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE IBBUINO INSURER I ILL MKMXVVJM MNL <br />*30 DAYS MWTTEN NOTICETO THE CERTIFICATE NoLOER NAMEOTO THE LEFT. <br />AUTNORU:ED REPRESENTATIVE <br />dDACORD CORPORATION 196E <br />£-d S£2bTLS:01 :WOb3 d10:90 bOO2-b2-NCf <br />