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Jan 12 10 10:07a OCCTAC 7145649690 p.2 <br />ACORa CERTIFICATt OF LIABILITY INSURAN%,E <br />DATE (MMA DfY <br />11/3o/WYYYYy <br />PRODUCER (714) 838-1912 FAX (714) 838-7568 <br />Lake Insurance Agency <br />13891 Newport Ave., Suite 28S <br />Lit #0747473ALTER <br />Tustin, CA 92780 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE MAIC <br />INSURED Orange County Children's Therapeutic Art Center <br />2215 N. Broadway <br />Santa Ana, CA 92706 <br />INSURERA Philadelphia Insurance Co. <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />INSURER E <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 />INSR <br />ADDL <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />POLICY EXPIRATIONjj&NSRr <br />LIMITS <br />AUTHORIZEDREPRESENTATI ° �. <br />GENERAL LMILITY <br />PHPK495 599 <br />12/21/2009 <br />12/21/2010 <br />EACH OCCURRENCE $ 11100010001 <br />X COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED S 100,000 <br />MS <br />CLAMADE a OCCUR <br />4-1 <br />MED EXP (Any one person) 5 5,0001 <br />A <br />PERSONAL & ADV INJURY S 1,000,00( <br />GENERAL AGGREGATE $ 2,000,00 <br />GEWL AGGREGATE LIMIT APPLES PER: <br />PRODUCTS-COMPIOP AGG $ 21000.00( <br />PCLICYF_j JJECT LCC <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LMIT <br />ANY AUTO <br />(Ea a;c-dem) t <br />11000,000 <br />BODILY INJURY <br />ALL OWNED AUTOS <br />- <br />A <br />SCHEDULEDAUTOS <br />(Per person) $ <br />X <br />HIREDAUTOS <br />PHPK49SS99 <br />12/21/2009 <br />12/21/2010 <br />X <br />NON-OWNEDAUTOS <br />BODILY INJURY f <br />(PerasideM) <br />DAMAGE S <br />FPROPERTY <br />(Per aocident) <br />GARAGE LIABILITY <br />Iola <br />ONLY - EA ACCIDENT $ <br />ANY AUTO <br />n9AUTO <br />r- <br />&–. <br />OTHER THAN EA ACC $ <br />el. <br />AUTO ONLY: AGG $ <br />EXCESSIU MBRELLA LIABILITY <br />• <br />Y <br />EACH OCCURRENCE $ <br />OCCUR O CU1MS MADE <br />PSs�ista <br />t C1�f Attorn <br />AGGREGATE $ <br />$ <br />DEDUCTIBLE <br />L/ <br />s <br />RETENTION $ <br />6 <br />WOR10EftSCOMPENSATION AND <br />wCSTATIh I OTH- <br />ER <br />EMPLOYERS LIABILITY <br />E.L. EACH ACCIDENT S <br />ANY PROPRIETOPJPARTNER✓aXECUTIVE <br />OFFICERVEMBER EXCLUDED, <br />E.L. DISEASE -FA EMPLOYEE, $ <br />If yes, tlesarbe unser <br />E.L. DISEASE - POLICY LIMIT $ <br />SPECIAL PROVISIONS be:ow <br />Professional Liability <br />PHPK495599 <br />12/21/2009 <br />12/21/2010 <br />Incident Limit: 41,000,000. <br />A <br />Aggregate Limit: 42,000,000. <br />,PESCFqPTIPN OF OPERATIONS I LQCATIO S I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PRO1/ISN)NS <br />ertificate holder is Additional Insured as per form CG205 (11/85) <br />use & Molestation is included with General Liability, 425,000 Eash Incident and $50,000 Aggregate <br />his Insurance Shall be Primary and Non -Contributory but Only in the Event of the Named <br />nsured's Sole Negligence <br />10 Day notice for non-payment of premium <br />The City of Santa Ana, its Officers, Agents, <br />SHOULD ANY OF TH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />Employees & Volunteers <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />Attn: Frances Cadenas/Donna Schultz <br />30': DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />888 W Santa Ana Blvd. <br />BUT FAILURE TO MAIL SUCH NOTICE SHALL IMP05E NOOBLIGATION OR LIABILITY <br />Suite 200 <br />OF ANY KIND UPON THEIN R. ITS AG�M OR REPRESZNTATWES. <br />Santa Ana, CA 92702 <br />AUTHORIZEDREPRESENTATI ° �. <br />ACORD 25 (2001108) OACORD CORPORATION 1988 <br />