Laserfiche WebLink
10 <br />f' <br />ACORD CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <br />04/18/2007 <br />PRODUCER (714) 838-1912 FAX (714) 838-7568 <br />Lake Insurance Agency <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />13891 Newport Ave . , Suite 285 <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE NAIC # <br />L i c #0747473 A-2007-105-006 <br />Tustin, CA 92780 <br />INSURED Cambod i an Fam i I y <br />INSURER A: Philadelphia Ind. Ins. Co. <br />INSURERB: <br />1111 East Wakeham Avenue <br />INSURER C: <br />Suite E <br />INSURER D: <br />Santa Ana, CA 92705 <br />INSURER E: <br />EACH OCCURRENCE $ 1,000,000 <br />V -RUMMY <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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />DD' <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTNE <br />DATE Cmminnmq <br />POLICY EXPIRATION <br />LIMITS <br />GENERAL LIABILITY <br />PHPK213206 <br />03/09/2007 <br />03/09/2008 <br />EACH OCCURRENCE $ 1,000,000 <br />DAMAGE TO RENTED $ 400,00C <br />X COMMERCIAL GENERAL LIABILITY <br />MED EXP (Any one person) $ 5 , 00 <br />CLAIMS MADE F—X] OCCUR <br />PERSONAL & ADV INJURY $ 1,000,00C <br />A <br />GENERAL AGGREGATE $ 3 , 000 , OQ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $ included <br />17 <br />POLICY jRa LOC <br />AUTOMOBILE <br />LIABILITY <br />PHPK213206 <br />03/09/2007 <br />03/09/2008 <br />COMBINED SINGLE LIMIT <br />ANY AUTO <br />(Ea accident) $ 1,000,000 <br />BODILY INJURY $ <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />(Per person) <br />A <br />BODILY INJURY $ <br />X <br />HIRED AUTOS <br />X <br />NCN-OWNEDAUTOS <br />accident) <br />(Per accident) <br />PROPERTY DAMAGE $ <br />X <br />I <br />$0 Deductible <br />(Per accident) <br />GARAGE LIABILITY <br />.ems .. ii a> <br />J-> <br />T F�^, N • •;�_ <br />:+ <br />jV�. <br />AUTO ONLY - EA ACCIDENT $ <br />ANY AUTOOTHER <br />THAN EA ACC $ <br />AUTO ONLY: AGG $ <br />EXCESS/UMBRELLA LIABILITY <br />�--- <br />EACH OCCURRENCE $ <br />OCCUR FICLAIMSMADE <br />i ali;3 SI <br />_ <br />-1, <br />AGGREGATE $ <br />$ <br />Assimat <br />ity Attor'-,�Y <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />WORKERS COMPENSATION AND <br />- <br />WC STATIT OTHER <br />EMPLOYERS' LIABILITY <br />E.L. EACH ACCIDENT $ <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. DISEASE -EA EMPLOYE $ <br />OFFICER/MEMBER EXCLUDED? <br />If yes, describe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE - POLICY LIMIT 1 $ <br />ER &Molestation <br />PHPK213206 <br />03/09/2007 <br />03/09/2008 <br />$1,000,000 Each Claim <br />A <br />$1,000,000 Aggregate <br />$0 Deductible <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />*Except 10 days for non payment of premium. Employee Dishonesty $200,000/$2,500 Ded. <br />rofessional Liability $1,000,000 Each Occ/$3,000,000 Aggregate. City of Santa Ana <br />is named additional insured per contract with named insured. Schedule of vehicles <br />rid drivers on file. "Non Profit organization" <br />The City Of Santa Ana: Its Officers,Employees <br />Agents, representatives <br />20 Civic Center Plaza (M-30) <br />Santa Ana, CA 92705 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL WWOMUd MAIL <br />30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT <br />i(IXi�XdCXAUL�i!fdH4116fD�lf lE►Y/I(lCNdkD(3i�X�H(aYtltXildf�df�14XA�1(>QrXXX. <br />ACORD 25 (2001/08) FAX: (714) 571-1974 l -'—=CORD CORPORATION 1988 <br />