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<br />.~fr1 2-.S- <br /> <br />--- <br /> <br />jJCORQ CERTIFICATE OF LIABILITY INSURANCE <br />PRODUCER (714) 838 .191 2 <br />Lake I nsuranee Agency <br />13891 NeWport Ave.. Suite 285 <br />Lie #0747473 <br />Tustin. CA 92780 <br />INSl/REQ Orange County Ch J I dren . s Therapeut i c <br />Art Center. lne <br />2215 N. Broadway <br />Santa Ana. CA 92706 <br /> <br />fAX (714)838-7566 <br /> <br />OATI!\IIIIIIlDIYYYYl <br />08/01/2007 <br />THIS CERnFICATE IS ISSUED AS A MATTER OF INFORMA nON <br />ONLY AND CONFERS NO RIGHTS UPON THE CERnFICATE <br />HOLDER. THIS CERnFICATE DOES NOT AMEND, EXTeND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> <br />INSURERS AFFORDING COVeRAGE <br />INSUIlEIl A: Cha i xlWestern Her ita e I ns . Co <br /> <br />NAIC' <br /> <br />INSURER B: <br /> <br />INSUl'lER C: <br /> <br />THE POLICIES OF INSURANCE LISTED BElOW HAve BEEN ISSUED TO THE INSURED NAMED ABOVE fOR THE POLICY PERIOD INOICATED. NOTWITHSTANDING <br />ANY REQUIREMENT. TERM OR CONCITlON OF PiXY CONTAACT OR OTHER DOCUMSNTWlTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN. TIlE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS NlO CONomONS OF SUCH <br />.s. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ClAIMS. <br />IN''' TYPE OF lNSURANCI POCJCY NUMBER pOUCY ~""CTI pOLICY RA'""" .. <br /> UIIITlI <br /> ~NERALUA.UTY SCP0618374 08/0212007 08/0212008 ~ oc;cuRIW'<CE s 1,000.00C <br /> ~ COMMERCIAl. GENEAAlllAIllUTY ~TOAEHTEl) S 50,OOC <br /> - b CLAIMS "'ADE ill OCCUR IAeD EX!' (My.... p"'''''1 I 5.00 <br />A PEASOtlAl & AeN INJURY I 1.000.00 <br /> GENERAL AGGREGATe s 2.000.00 <br /> nN'Ln~LIIIITAPnPeR PROOUCTs-COMPIOPAGQ S 2.000.00 <br /> POLICy ~ LOC <br /> ~1ITO_LIl LlA8lUTY COMIllNED SINll1.E UMIT S <br /> - Nf'f AUTO (e'_"1 <br /> '- . ALL OWNED AUTOS 'to '!OyJ A BODILY INJURY <br /> S <br /> - SCHEDUl.EO AUTOS ~i~ - (Pw' ...-1 <br /> lIIREO "UTOS ~ ....- <br /> - BOClLY INJIJAY <br /> NON-OWNED AUTOS ~ l?W-q S <br /> ~ <br /> :=fo~C" PROPER'IY OI'MAGE s <br /> .....,..yne'l .... ",..-lICd4enII <br /> =fEUAmun -- p.s-;~'r..an'r.. -c ~~r 0 -F ~) AUTO ONLY .EA.ACCIDENT S <br /> ANY AUtO I OTHER THAN EA...CC I <br /> AVTO ONLY: AGO S <br /> ::rISlUIlIlRELUI tlASlUTY \ EACH OCCURRENCE S <br /> OCCUR 0 CVoIMS w.DE AOGREOATi 1 <br /> Fl= I <br /> I <br /> S S <br /> 1IIORKERS CQMPIiJlSATIOn AIID 1111CSTAT\Jo T I~ <br /> ElIl'LOVERS' UABIUTf <br /> ANY PAOPAlErOM'ARTN~cunVE E.L EACH ACCIDEHl S <br /> OFFlCEMIEMIlER iXCtUOfl)? &1.. OISE11SE-EAEMPLQYE S <br /> ~~WSIO'NS_ E.L. DlGEASIl- POUCY UIollT S <br /> :ft":!~ctors & Off'i CerS PHSD259001 08/0712007 08/0712008 LimiL - $500.000 Polj~y Period <br />8 L1abi I it)' Limit - $500,000 Aggregate <br />~~TIpN DP OPERATIONS I LQCAlIONI/VEIlIa.ea16CLUIIONS AOoeD liT EIlD~~T IIIPGII'l. pm'IO~ <br />rtlflcate Holder IS Additiona Insured as per orm CG2026 11 85 Primary & Non-Contributory <br />~rding applies as per form WHI200106 (03/99) <br />.'0 dClYS for non-paymen~ of pre~ium <br />----~_. . --- <br /> <br />l..auftV' ~ <br />fiSURER i: <br /> <br />c 0 <br /> <br />CAN I. N <br />SHOULD AHT OF TIlE ABOVE DESCRIBED POLICIElI BE CAHCEu.E'O SEFDIIE TIlE <br />EllPlR"nON DAn THEREOF. THE ISSUING INSUftl9' WILL ~ Il/IolL <br />~ DAYS WIltTTEN NDnCE TO THI! c&R11F1CAT&. HOLDE" IlAIlEDTO THE LEFT. <br />~lU'~ ~l(~XX. <br />~~ XXXXXlC <br />AUTllOlOIZED REPRESENTA'I1VR <br /> <br /> <br /> <br />THE CITY OF SANTA ANA <br />Attn: frank Hernandez <br />PO BOX 1988 <br />Santa Ana. CA 92702 <br /> <br />ACORD25(2001108) FAX: (714)647-65-49 <br /> <br />eACORD CORPORAflON 1988 <br /> <br />~'d <br /> <br />Sf:2t>lLS:0l <br /> <br />:WO~ d10:90 t>002-t>2-N~f <br />