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<br />.. <br /> <br />.r- <br /> <br />ACORQ" <br /> <br />CERTIFICATE OF LIABILITY INSURANCE <br />FAX (714)838-7568 <br /> <br />DATE (MMlDDIYYYY) <br />04/18/2007 <br /> <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 />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> <br />PRODUCER (714) 838-1912 <br />Lake Insurance Agency <br />13891 Newport Ave., Suite 285 <br />Li c #0747473 <br />Tustin, CA 92780 <br />INSURED Cambod i an Fam i I Y <br />1111 East Wakeham Avenue <br />Suite E <br />Santa Ana, CA 92705 <br /> <br />A-2007 -105-006 <br /> <br />INSURERS AFFORDING COVERAGE <br /> <br />INSURER A: Ph i I ade I ph i a I nd. I ns. CO. <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />INSURER E: <br /> <br />NAIC# <br /> <br />cnVI"RAr.:I"~ <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWlTHSTANDING <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 DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRA noN LIMITS <br /> GENERAL LIABILITY PHPK213206 03/09/2007 03/09/2008 EACH OCCURRENCE $ 1,000,00C <br /> '-- <br /> X COMMERCIAL GENERAL LIABILITY ~~~~~~JO RENTED $ 400,00C <br /> I-- ~ CLAIMS MADE [8] OCCUR <br /> MED EXP (Anyone person) $ 5,00C <br /> I-- <br />A PERSONAL & ADV INJURY $ 1,000,00C <br /> I-- 3,000,00C <br /> I-- GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP~PAGG $ included <br /> h POLlCy-n ~:g,: n LOC <br /> AUTOMOBILE LIABILITY PHPK213206 03/09/2007 03/09/2008 COMBINED SINGLE LIMIT <br /> I-- $ <br /> Am AUTO (Ea accident) 1.000.00C <br /> I--- <br /> I--- ALL OVVNED AUTOS BOOIL Y INJURY <br /> SCHEDULED AUTOS (Per person) $ <br />A I-- <br /> X HIRED AUTOS BODILY INJURY <br /> fy NON-OVVNED AUTOS (Per accident) $ <br /> --'- <br /> X $0 Deductible PROPERTY DAMAGE <br /> - $ <br /> (Per accident) <br /> ~RAGE LIABILITY APPROVED ,("'O..,....r. F01 ,.M AUTO ONLY - EAACCIDENT $ <br /> ..Ii.....) ..: ',-," <br /> ANY AUTO EA ACC $ <br /> jl/.t2 / .J... OTHER THAN <br /> . ...1 AUTO ONLY: AGG $ <br /> ~ESSlUMBRELLA UABILlTY //-M-= . II~ - EACH OCCURRENCE $ <br /> OCCUR 0 CLAIMS MADE tJ: "T <br /> I Laura S tt l'-""-"1Y AGGREGATE $ <br /> ~i.c J. .............. <br /> AS,lstailt ( ity Atlor:."~Y $ <br /> ~ DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND I '<\C STATU- :T TOJ~. <br /> EMPLOYERS' LIABILITY <br /> ANY PROPRIETORlPARTNERlEXECUTIVE E.L. EACH ACCIDENT $ <br /> OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEI $ <br /> If yes. describe ""der <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ <br /> ~HER PHPK213206 03/09/2007 03/09/2008 $1,000,000 Each Claim <br /> ~ use & Molestation <br />A $1,000,000 Aggregate <br /> $0 Deductible <br />DESCRIPTION OF OPERATIONS I LOCA noNS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />*Except 10 days for non payment of premium. Employee Dishonesty $200.000/$2,500 Ded. <br />Professional Liabi I ity $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 />~nd drivers on fi Ie. "Non Profit organization" <br /> <br /> <br />7 <br /> <br /> <br />ORD CORPORATION 1988 <br /> <br />C <br /> <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 /> <br />ACORD 25 (2001/08) FAX: (714) 571-1974 <br />