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<br /> ACDBD,. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDrYYYYl <br /> 04/17/2008 <br /> "RODUCER (714)838-1912 FAX (714)838-7568 THIS CERTIFICATE IS ISSUED AS A MATl"ER OF INFORMATION <br /> Lake Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 13891 Newport Ave., Suite 285 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> L ic #0747473 <br /> Tust;n, CA 92780 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED Cambodian Family INSURER A: philadelphia Ind. Ins. Co. <br /> 1111 East Wakeham Avenue INSURER s" philadelphia Insurance Co. <br /> Suite E INSURER c' K.Freeman/Philadelphia Ind. <br /> Santa Ana, CA 92705 INSURER 0: <br /> INSURER E: <br /> Cnv -- <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 />I~~!t ~RD' TYPE OF INSURANCE pOLlev NUMBER p~UCy EFFECTIVE PQUCY EXPIRA110N u..,rs <br /> ~NERAL UABIUTY PHPK290824 03/09/2008 03/09/2009 EACH OCCURRENCE . 1,000,000 <br /> X COMMERCIAL GENERAL LIABIliTY DAMAGE TO RENTED . 100,000 <br /> I ClAIMS MACE 0 OCCUR MED EXP (Any one person) . 5,OO( <br /> A ~ PERSONAl & ADV INJURY . l,OOO,OO( <br /> - GENERAL AGGREGATE . 3,000,00( <br />, ~.~ AGG~EnE ~LlMIT APnS1PER: PROQUCTS - CQMP/OP AGG . l,OOO,OO( <br />I PRO- <br /> POLICY JEer lOC <br /> ~TOMOBlLE LIABILITY PHPK290824 03/09/2008 03/09/2009 COMBINED SINGLE LIMIT <br /> ANY AUTO (Ea accident) . l,OOO,OO( <br /> - <br /> - ALL OWNED AUTOS BQOll Y INJURY <br /> SCHEDULED AUTOS (Per person) . <br /> A ~ <br /> ~ HIRED AUTOS <br /> BOOll Y INJURY . <br /> .!. NON.OWNED AUTOS (perac:odenl) <br /> PROPERTY DAMAGE . <br /> (Peracoden1) <br /> =fOE UABIUTY AUTO ONLY. EA ACCIDENT . <br /> ANY AUTO EA ACC . <br /> OTHER THAN <br /> AUTO ONLY: AGG . <br /> r=]"SSlU.BRELLA UABIUTY EACH OCCURRENCE . <br /> OCCUR 0 CLAIMS MADE AGGREGATE . <br /> . <br /> =1 DEDUCTIBLE '( \11 .. , -lc 1/> . <br /> RETENTION . t-J''''- --<: , "-- . <br /> WORKERS COMPENSATION AND I I ~"J,~T"", I IDJb'" <br /> EMPLOYERS' UABIUTY <br /> ANY PROPRIETORJPARTNERJEXECUTlVE E L. EACH ACCIDENT . <br /> OFFICER/MEMBER EXCLUDED? E L. DISEASE - EA EMPLOYEE $ <br /> If yell. della1be under <br /> SPECIAl PROVISIONS belOW' E.L. DISEASE. POLICY LIMIT . <br /> ~ER PHPK290824 03/09/2008 03/09/2009 $1,000,000 Each Claim <br /> use & Molestation <br /> A $1,000,000 Aggregate <br /> DESCRlPTlON OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDEO BY ENDORSEMENT 1 SPECIAL PROV1SIONS <br /> Except 10 days for non payment of premium. Employee Dishonesty $200,000/$2,500 Oed. <br />"ity of Santa Ana is named additional insured per contract with named insured. <br /> *10 days Notice of Cancellation shall be given in the event of non-payment of premium. <br /> <br />. <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 />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ~ MAil <br />30* DAYS WRITTEN NOTICE TO THE CERTlACATE HOLDER NAMED TO THE LEFT, <br />~~~_JII(~X <br />~JIlOOil(JlIlilOtllXlOOtllliKM*X~XJll"~1()()()()(XXXX <br />AUTHOIUlED1tEPRES~11VE.. / ,. <br /> <br />ACORD 25 (2001/08) FAX: (714)571-1974 <br /> <br />1!:)ACORD CORPORATION 1988 <br />