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ACORD. CERTIFICATE OF LIABILITY INSURANCE " <br />°" <br /> 9/2 <br />9/2009 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />GLOBAL PROGRAM MANAGERS & INSURANCE SERVICES, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />POST OFFICE BOX 7119 HOLDER. 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 /> INSURERS AFFORDING COVERAGE NAIC # <br />INSURED INSURERA: PHILADELPHIA INDEMNITY 18058 <br />ORANGE COUNTY YOUTH COMMISSION INSURER B: LIFE INSURANCE COMPANY OF N.A. 65498 <br />1850 E. 17TH STREET, SUITE 220 INSURERC: <br /> <br />BANTA AN <br />CA 92705 NSURER°: <br />, <br />rnvveAr??. INSURER E: <br />c rVLI dI= Vr IN3URANUE us I ELI UELV W HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED <br />NOTWITHSTANDING <br />. <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE <br />D OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS <br />EXCLUSIONS AND CONDITI <br />, <br />ONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />A <br />INSR AISIV <br />I <br /> <br />POLICYNUMBER <br />POLICY EFFECTNE <br />POLICYE%NMTON <br /> LIMITS <br /> GE NERAL DABRITY EACH OCCURRENCE E 1,000,000 <br />A X X MMMERCIALGENSRAJ- LIABILITY P 300 <br />000 <br /> ES Ea <br />P=ImnW , <br />E <br /> T <br />CLAIMS MADE 1XI OCCUR PHPK 476 363 10/20/2009 10/20/2010 MED EXP(M me en ) E 5,000 <br /> PERSONAL S ADV INJU 1 <br />000 <br />000 <br /> RY , <br />S <br />1 <br /> GENERAL <br />GG 2 <br />000 <br />000 <br /> A <br />REGATE , <br />, <br />S <br /> GE <br />--I N'L AGGREGATE LIMITAPPLIES PER <br />PRO- PRODUCTS -COMP/OP AGG E 2,000,000 <br /> X POLICY <br />LOC <br />F1 <br /> AUT OMOBILELIABILITY <br /> COMSIN ED SINGLE LIMIT <br />E <br /> ANYAUTO ?M1 <br />v?' (Es ar denO <br /> ALL OWNED AUTOS ? <br />l <br /> to BODILY <br />r <br />) RY $ <br /> SCHEDULED AUTOS ?C <br />i7 ., . <br />, <br /> HIRED AUTOS r <br />f <br /> ?l <br />? BODILY INJURY <br /> NON-OWNED AUTOS QR <br />L/ <br />(Per sWEant) E <br /> e <br />O? <br /> C <br />` ey PROPERTY DAMAGE <br /> (r. <br />J <br />t <br />(Per ?der,0 S <br /> GARAGE LIABILITY nt \ <br />a AUTOONLY-EAACCIDENT S <br /> ANY AUTO fM.?`- G?rP\5 <br />F EA ACC <br />OTHER THAN S <br /> AUTO ONLY: <br />AUTO ONLY: AGG <br />S <br /> E)ICESSNMBRELLALNBILRT EACH OCCURRENCE E <br /> OCCUR ?CLAIMS MADE AGGREGATE E <br /> E <br /> DEDUCTIBLE <br /> E <br /> RETENTION E E <br /> WORMERS COMPENSATION AND WC STATU- OTH- <br /> EMPLOYERS'LUUNUT' <br /> <br /> ANY PROPRIETOMPARTNEWEXECONVE El EACH ACCIDENT E <br /> OFFICERIMEMBEREXCLUDED? <br /> 11 yyees, EeeOlbe U^Eer E.L. DISEASE-FA EMPLOYEE b <br /> SPECW. PROVISIONSbelw E.L DISEASE-POLICY LIMB $ <br /> OTHER AD&D AGG Limit - $500,000 <br /> Accident Medical Excess MhX Accident Med Exp - $25 <br />000 <br />B BA33040001 10/20/2009 10/20/2010 , <br />AD&D - $50 <br />00 <br /> Coverage , <br /> Accidental Death - $15,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I E%CLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS <br />Certificate holder as Additional Insured (see attached policy form PI-NP-003)per Item M - Funding Source <br />added blanket Additional Insured. <br />IN THE EVENT OF NON-PAYMENT OF PREMIUM, ONLY TEN (10) DAYS NOTICE WILL BE GIVEN. <br />CERTIFICATE HOLDER <br />ATlnu <br /> <br /> SHOULDANYOF THEASOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />CITY OF SANTA ANA DATE THEREOF, THE ISSUING INSURER WILL BHMEAVOD13 MAIL 30 DAYS WR EN <br />COMMUNITY DEVELOPMENT AGENCY M-25 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, YJC?' <br />P.O. BOX 19BB <br /> ? iF11WEKdL9C <br />SANTA ANA, CA 92702-1988 AUTH RESENIATNE <br /> (AF614 419r6 S0S <br />Arnon Di T9nMMGI <br />® ACORD CORPORATION 11988