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ACORQ, CERTIFICATE 4F LIABILITY INSURANCE <br />(949 305 -6161 FAX 49 305 -6166 T 18CERTI CATS IlSUEDABA <br />Colonial Western Inwranca Agency ONLYANDCONFER!►1pRgNT3Ul <br />26691 plaza Drive, suite 220 NOLDBRTNIaC@BTIFiCATEDOEBI <br />Mission Viejo, a 92691 �TmT06MAGEAFFOROEG <br />4211 E. in Palma AVe. mow, <br />Anaheim, CA 92107 p - 20�Y1—/ 4/ <br />I - aoa8 -D4--- <br />L"U'A <br />OCOUR "aAM"MADE <br />DEDUCTIBLE <br />A <br />IF SVCH <br />1rp00, <br />1.000. <br />1 <br />C lei w•imie%:etnEZawem y„Y`L._I e.L.eAp,ACCnExr 6 1,000, <br />0( <br />IlwAa � &10 el_OISEA9E.EAEMPLOrE i _ OC <br />Ie�E�414 Mi�90Y1910N8 EeMU I,000, <br />RL EL OmEASE- POLICYt.INFT i 1 000 Dd <br />A ro ssional Liability LHC112193 00/01/2009 08 01/2010 Prof Liability: Slmii/ 3rnil <br />Managed Care E&O Liab. LHCBI2193 08/01/2009 08/01/2010 Managed Care E&0: $1mil/S3mil <br />DEee[vnonOFOVewTTOn[.(LawTron4 vEww��p[ftl(Cl.UeOFI {AODmer eNF? SWALLMOYxIONe '--- -- -- <br />10 pays natice of canr:elllation for non- payment of prom um. <br />ertificate Holder is an Additional Insured for general liability and professional liability per <br />ndorswnexts (Additional Insured - Designated Person or Organization & Waiver of Transfer <br />IF Rights of Recovery Against Others To Us) attached. <br />I <br />CERTIFICATE HULOER <br />- _..... ... _.._.....--- _ -- --' CANCELLATION <br />SNOULOANY OF 7ME ABOVE OESCRMEn POUCI46 BE CARCELLEO BUORR THE EXPIMnO <br />DAT87NEREOf. 7WE ]"UmOWBURERVALL[NOEAVORTOMAR. :30, DAYSWRITTEN <br />NOTICE TOME CERRFICATB ROL.OER NANED TOME LEFT. BUT FAILURE TO W SO SMALL <br />IMPDEE NOOSMOATION OR LIABk DY OF ANY Koo BAON 7NEIN8URER.OS AO[NTS OR <br />Ci ty of Santa Ana REPRES FATN <br />62 Civic Center Plaza AvnN)Ba4O nEP nTaE <br />Sa to Ana, CA 92702 <br />— i__---- '-. - -- --- _. _ . _ ... _... _ -.._._ Don Emor <br />28 (2003101y G 1980;MArIORD CORPORATION. All rights reserved, <br />The ACORD nerve and logo Aar rRgiefered'""k Of AC4 <br />CUMMPNCVLL UENERPI. LVUIILNY <br />I X ICW413 <br />E, <br />. <br />i <br />- fI MOUE I UCCOft <br />""'� <br />A <br />1 i <br />MEO ENP {Hry arolx.mnJ <br />i <br />i <br />fl -.. - -I <br />PEReONN &AW NUWi'f -..�i <br />J OENL AOOREOATC LIMRAPPLILB PER' <br />J <br />I <br />POLICY <br />I I p _. L_..�40C <br />6809447H706 <br />02/04/2009 <br />02/04/2010 <br />TiW'iWCT3 CaWOPA00 <br />—� - - <br />, 6 <br />+— <br />I <br />iANrDMOeLEUneam <br />ANY AUTO <br />JE BPD 8INOLG LIMIT <br />4 <br />li <br />I All 0 0 AUTO8 <br />... _... <br />__..__ <br />i <br />a <br />I BCIEDULEO AUTOS <br />�7 <br />(� 1Y mIURY <br />I A I IIIRERAUf08 <br />_— _ <br />NON -01NIED AUT03 <br />%r� <br />�POOIL��Y <br />i <br />JL <br />n,e <br />f <br />i n <br />PROPERTY UAMAOE <br />IPKtlCNtleMJ <br />6LWI[RY <br />ANYAVFO <br />I Ryan <br />AUTO OFA.Y -EA Ap.'!OEMI <br />.... -- <br />1 <br />- <br />t <br />ggouq Q <br />A J71ay <br />aT�NAYN eAACD <br />OCOUR "aAM"MADE <br />DEDUCTIBLE <br />A <br />IF SVCH <br />1rp00, <br />1.000. <br />1 <br />C lei w•imie%:etnEZawem y„Y`L._I e.L.eAp,ACCnExr 6 1,000, <br />0( <br />IlwAa � &10 el_OISEA9E.EAEMPLOrE i _ OC <br />Ie�E�414 Mi�90Y1910N8 EeMU I,000, <br />RL EL OmEASE- POLICYt.INFT i 1 000 Dd <br />A ro ssional Liability LHC112193 00/01/2009 08 01/2010 Prof Liability: Slmii/ 3rnil <br />Managed Care E&O Liab. LHCBI2193 08/01/2009 08/01/2010 Managed Care E&0: $1mil/S3mil <br />DEee[vnonOFOVewTTOn[.(LawTron4 vEww��p[ftl(Cl.UeOFI {AODmer eNF? SWALLMOYxIONe '--- -- -- <br />10 pays natice of canr:elllation for non- payment of prom um. <br />ertificate Holder is an Additional Insured for general liability and professional liability per <br />ndorswnexts (Additional Insured - Designated Person or Organization & Waiver of Transfer <br />IF Rights of Recovery Against Others To Us) attached. <br />I <br />CERTIFICATE HULOER <br />- _..... ... _.._.....--- _ -- --' CANCELLATION <br />SNOULOANY OF 7ME ABOVE OESCRMEn POUCI46 BE CARCELLEO BUORR THE EXPIMnO <br />DAT87NEREOf. 7WE ]"UmOWBURERVALL[NOEAVORTOMAR. :30, DAYSWRITTEN <br />NOTICE TOME CERRFICATB ROL.OER NANED TOME LEFT. BUT FAILURE TO W SO SMALL <br />IMPDEE NOOSMOATION OR LIABk DY OF ANY Koo BAON 7NEIN8URER.OS AO[NTS OR <br />Ci ty of Santa Ana REPRES FATN <br />62 Civic Center Plaza AvnN)Ba4O nEP nTaE <br />Sa to Ana, CA 92702 <br />— i__---- '-. - -- --- _. _ . _ ... _... _ -.._._ Don Emor <br />28 (2003101y G 1980;MArIORD CORPORATION. All rights reserved, <br />The ACORD nerve and logo Aar rRgiefered'""k Of AC4 <br />