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<br />~ AcoR~,~ CERTIFICATE OF LIABILITY INSURANCE <br />anrE (r+twoD <br />PRODUCER 9/29/20 ri) <br />GLOBAL pROGRAM MANAGERS & INSURANCe sBRVZCBS, INC. ONLYCANDIFCONFER3SNOERIOH7 UPON THE ICERT F CATS <br />pOST OFFICE BOX 7119 HOLDHR. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />CAPISTRANO BEACH, CA 92614-7119 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />(949) 218-0840 CA License # OC64508 <br />INSUR>:D INSURERS AFFORpfNT3 COVERAGE NAIC;'~ <br />ORANGE COUNTY YOUTH COMldTSSION IkSVRERA: P}lILADSLPHIA INDSMNITy 18058 <br />IksURERB: LIFE INSURANCE COIdPANY OF N.A. 65498 <br />1850 B. 17TH STREBT, SUITZ{ 220 FNSURERC; <br />SANTA AN~1, CA 92705 INSURER D: - <br />THE POL[CIES OF INSURANCE LiS€EO BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICATEO. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR COND1T10N 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. ARGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. <br />R 41LY ~.--__...__.. <br />A X X COAf),4ERCIALGENER <br />A <br />LL <br />UU1~fTY EACH OCCURRENCE 3 1, 000, OOO <br />f <br />~ <br />1 <br />cLA1MS MAOE ~1 OCCUR E E S 300 <br />000 <br /> p}}pK 476 363 10/20/2009 10/20/2020 MEO EJ(P An ons rsan S , <br />5, 000 <br /> PERSOkaLaAavw.luRV ; 1, pOD, 000 <br />GEN'LApOREG,ATELIMRAPPUE$pER: GENERALAGGAEOATE S 2,000,000 <br />X POLICY PRO' LOC PRODUCTS-COMPlOPAGG S 2, 0 <br />00, Q00 <br />AUTOMOBILE LU>,b1LfTY _ ^_ <br />ANYAUiO COl <br />B <br />IN <br />SINGCELBNIT <br /> <br />ALLOWNEOAUTOS ,~~,yRR ~ <br />( <br />a <br />~I <br />= <br />) <br />SCHEDULED AUTOS ~ <br />T(IQ Yr <br />it BObILYIkJURY ~`- <br />kIRE0AUT03 fiS iy {Par parson) S <br />NONgWNEOAUTOS ,~+I <br />~~g v~ <br />Lti i~ G <br />(-,i 800ILY1NJURY <br />(Per acddant) S <br /> C <br />R <br />c <br />~o `' <br />0J <br /> tt~ <br />~~ <br />j D <br />AMP.cE 5 <br />(e°A <br />o a <br />~ <br />OAf1A0ELIABILnY ~ ) <br />s <br />a <br />nl <br />ANY AUTO A~5` a~~ AUTO ONLY-EA ACCIDENT S <br /> T~``'"'' OTHER THAN ~A~ S <br />EXCfSSlU1,IBRELlALUBIUTY AUTO ONLY: AGG S <br />OCCUR ~ CWMSLiAOE EACH OCCURRENCE S <br />DEWCTIBLE <br />WORKERS CWdPENSATON AND <br />EMPLOYERS' LIABILITY <br />AkY PROPRIETORlPARTNER/E%EC UPVE <br />OFfICERlMEMBERE%CLUDEO) <br />OTHER E.L. DISEASE -POLICY CIAIIT j <br />B Accident Medical Excess AD&D AGCS Limit - $500,000 <br />Coverage BA8040001 10/20/2009 10/20/2010 NAX Accident Ided Bxp - $25,000 <br />AD&D - $SD,D00 <br />ESCRip7lONOFOPERATiOkSlLOCATIONS7VEHICLESIEXCLU610NBADDEDBYENDORSEMENilSPECUILPROYISIOHS Accidental Death - $15,000 <br />Ceztificate holder as Additional Insured (see attached <br />added blanket Additional Insured. Policy form PI-NP-OD3)par item 6! - Funding source <br />IN THB BVENT OF NON-PAYMENT OF PREMIUM, ONLY TEN (1D) pAYS NOTICE S9ILL BE GIVEN. <br />CITY OP SANTA ANA <br />COIdMUNITY DfiVSLOPtdBNT AGENCY Al-25 <br />P.O. BOX 1968 <br />SANTA ANA, CA 92702-1988 <br />26 <br />SHOULD ANYOF THE ABOYfi DESCRIBED POLICIES BE CANCELLED BEFORE THE F%PIRATION <br />DATE 7HBREOF, 711E fSSUiNO INSURER YYILL Bfm}f118I071}[l! MIUL <br />NOTICE TO THE CERTIFICATE HOLDER NAMEO TO THE LEFT, •~~- DAYS WRITTEN <br />-~xr~axx4ascxcnx ~mL~xacm+=nxrrsclcet~or~c~c <br />m#ldAsYVwverrer <br />G,4.areflabd~oS <br /> <br />