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Al 1, <br />C E R )I F I Ci4T E aF4L'l k L <br />ITY f N ? <br />` ?N E r I 05/20/2009 <br />- <br />_ y , <br />_ <br />PRODUCER Serial # 100205 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />BLAKEMORE & ASSOCIATES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P.O. BOX 7737 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />SAN DIEGO, CA 92167 COMPANIES AFFORDING COVERAGE <br />619-222-4458 <br /> COMPANY PHILADELPHIA INDEMNITY INSURANCE CO <br /> . <br />A <br />INSURED COMPANY <br />LATINO HEALTH ACCESS B <br /> <br />1701 N. MAIN ST. <br />SANTA ANA, CA 92706 COMPANY <br /> C <br /> COMPANY <br /> D <br /> <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED B Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />CO <br />LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE <br />DATE (MM/DD/YY) POLICY EXPIRATION <br />DATE (MMlDD/YY) LIMITS <br /> GE NERAL LIABILITY PHPK420643 05/20109 05/20/2010 GENERAL AGGREGATE $ 2000000 <br />A X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $ 2000000 <br /> CLAIMS MADE ?X OCCUR PERSONAL & ADV INJURY $ 1000000 <br /> OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1000000 <br /> FIRE DAMAGE (Any one fire) $ 100000 <br /> MED EXP (Anyone person) $ 5000 <br /> AU TOMOBILE LIABILITY PHPK420643 05/20/09 0520/2010 <br />A X ANY AUTO COMBINED SINGLE LIMIT $ 1000000 <br /> ALL OWNED AUTOS <br />( DOILY IN RY <br />Per <br />erson <br />$ <br /> SCHEDULED AUTOS TO p <br /> X HIRED AUTOS <br /> BODILY INJURY $ <br /> X NON-OWNED AUTOS yr? (Per accident) <br /> <br />- <br />c? <br /> ,!i, IC ?0 <br />?, S <br />0,1 <br />'N' , ney PROPERTY DAMAGE $ <br /> GARAGE LIABILITY <br />1 ant AUTO ONLY- EA ACCIDENT $ <br /> ANY AUTO S / OTHER THAN AUTO ONLY: <br /> EACH ACCIDENT $ <br /> AGGREGATE $ <br /> EXCESS LIABILITY PHUB271881 05/20/09 05/20/2010 EACH OCCURRENCE $ 1000000 <br />A X UMBRELLA FORM AGGREGATE $ 1000000 <br /> OTHER THAN UMBRELLA FORM $ <br /> <br />WORKER'S COMPENSATION AND WC STATU- OTH- <br />TORY LIMITS ER <br /> EMPLOYERS' LIABILITY EL EACH ACCIDENT $ <br /> THE PROPRIETOR/ <br />PARTNERS7EXEIXJrIVE INCL EL DISEASE - POLICY LIMIT $ <br /> OFFICERS ARE EXCL EL DISEASE - EA EMPLOYEE $ <br /> OTHER <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlSPECIAL ITEMS <br />CITY OF SANTA ANA ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS IS NAMED ADDITIONAL INSURED PER ATTACHED <br />EXHIBIT B <br />T . CA: OILDILE tL -- <br />?? <br />a « <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />CITY OF SANTA ANA EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL EN615Q60 M MAIL <br />20 CIVIC CENTER PLAZA, M-21 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />SANTA ANA, CA 92701 <br /> AUTH <br />RIZED REPRESENTATIVE BLAKEMORE & ASSOCIATES <br /> O <br />? <br />St{7{95y r <br />G47RD25. - -rI}n jE[ RD;EfORPynRATIQNil B&#+ <br />CAFMPRO\CERTPROS LATINOHEALTHACCESS.FP5