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OP ID- PC <br />' `' CERTIFICATE OF LIABILITY INSURANCE <br />DAT10/071YYYY) <br />F 10/07/10 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER_ THIS <br />CERTIFICATE DOES <br />�3NOT <br />/J.AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS REPRESENTATIVE Of�t'Rt�Cr _4 -WMt AN E DOES CNNOE OLDER. UTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and concgi "+A oX the policy; certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in o€such. 0ndorsemeni 3 ). . <br />PRODUCERNAME: "'' ---' - 6.246-405-8031 <br />Chapman 626-405-0585 <br />License #0522024 <br />P. O. BOX 5455 <br />Pasadena, CA 91117-0455Tim M,Prm-St <br />CONTACT <br />PHONE FqX <br />A/C No Ert A/C No <br />E-MAIL <br />ADDRESS: <br />PRODUCER COMMU-6 <br />C TOMER D p: <br />INSURERS AFFORDING COVERAGE NAIC 0 <br />INSURED Community Service Programs,lnc <br />1821 E. Dyer Road Ste. 200 <br />Santa Ana, CA 92705 <br />INSURER A: Riverport Insurance Company 36684 <br />INSURER B :Everest National 10120 <br />INSURER C <br />INSURER D: <br />INSURER E: <br />INSURER F - E�] <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE <br />POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT <br />TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL <br />THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR LTR <br />TYPE OF INSURANCE <br />U <br />POLICY NUMBER <br />MM DD YYYY Y -EFF <br />MM DD/YYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,00 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />X <br />RIC0011342 <br />10/01/10 <br />10/01/17 <br />100,00 <br />PREMISES Ea occurrence $ <br />MED EXP (Any one parson) $ 5,00 <br />CLAIMS -MADE X] OCCUR <br />X Sexual Abuse <br />RIC0011342 <br />10/01/10 <br />10/01/11 <br />PERSONAL a ADV INJURY $ 1,000,00 <br />X PROFESSIONAL <br />GENERAL AGGREGATE $ 3,000,00 <br />CONTRACTUAL LIABILITY <br />10/01/10 <br />10/01/11 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />PRODUCTS - COMP/OP AGG $ 1,000,00C <br />POLICY PRof LOC <br />Emp Ben. $ 1,000,00 <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />A <br />ANY AUTO <br />RIC0011342 <br />10/01/10 <br />10/01/11 <br />(Ea accident) $ 1,000.00 <br />X <br />BODILY INJURY (Per person) $ <br />ALL OWNED AUTOS <br />COMP = $500 COLL = $SOO <br />BODILY INJURY (Per accident) $ <br />SCHEDULED AUTOS <br />X <br />PROPERTY DAMAGE <br />HIRED AUTOS <br />(Per accident) $ <br />X <br />NON -OWNED AUTOS <br />S <br />UMBRELLA LJAB <br />X <br />OCCUR <br />EACH OCCURRENCE $ 1,000,00 <br />AGGREGATE $ 1,000,00 <br />A <br />EXCESS LIAB <br />CLAIMS -MADE <br />R E L001 1343 <br />10/01/10 <br />10/01/11 <br />DEDUCTIBLE <br />$ <br />$ <br />RETENTION $ <br />WORKERS COMPENSATION <br />WC STATU- OTH- <br />X <br />AND EMPLOYERS' LIABILITY <br />Y/N <br />1,000,00 <br />B <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />6600000007101 <br />07/01/10 <br />07/01/11 <br />OFFICER/MEMBER EXCLUDED? <br />N / A <br />E.L. EACH ACCIDENT $ <br />E. L. DISEASE - EA EMPLOYEE $ 1,000,00 <br />(M es des NH) <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT 1 $ 1,000,00 <br />DESCRIPTION OF OPERATIONS below <br />A <br />Employee Dishonest <br />RICOO11342 <br />10/01/10 <br />10/01/11 <br />& Forgery 650,00 <br />A <br />Property <br />FUC0011342 <br />10/01/10 <br />10/01/11 <br />Contents 249,00 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addltlonal Remark, Schedule, If more space Is requlred) <br />Re: Positive Action Towards Health Grant. City of Santa Ana, Santa Ana <br />Police Department, its officers and employees are named additional insured <br />and any other insurance be deemed PROVED AS IM RM <br />shall excess coverage and named insured's <br />insurance shall be primary - CO 2026 endorseemnt to follow. Worker <br />com ansa i overs exclud d eviden a onl . 10 da s notice of Contd... <br />V MI�VCLLM 11VIY <br />SANPOLI <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Santa Ana Police Department ACCORDANCE WITH THE POLICY PROVISIONS. <br />60 Civic Center Plaza <br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE <br />c� 19BS-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />