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_ACORD DATE (MM/DD/YYYY) <br />TM CERTIFICATE OF LIABILITY INSURANCE 03/24/2010 <br />PRODUCER (714)838-1912 FAX (714) 838-7568 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Lake Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />13891 Newport Ave., Suite 285 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Lic #0747473 <br />Tustin, CA 92780 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED The Cambodian Family INSURER& Philadelphia Ind. Ins. Co. <br />1111 East Wakeham Avenue INSURERB: Philadelphia Insurance Co. <br />Suite E INSURERC: <br />Santa Ana, CA 92705 INSURER D: _ .=?r <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 A(C PF=r-aTF I innlTS QI.InIAM KAAV UAVO DOCK. --- n <br />INSR DD' TYPE OF INSURANCE POLICY NUMBER _ POLICY EFFECTIVE <br />DATE (MMtDD/YY) POLICY EXPIRATION LIMITS <br /> GENERAL LIABILITY <br />X PHPK528579 03/09/2010 03/09/2011 EACH OCCURRENCE $ 1,000,000 <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED <br />" Prance) $ 100,000 <br /> <br /> <br />A CLAIMS MADE OCCUR MED EXP (Any one <br />person) <br />$ 5,00( <br /> PERSONAL & ADV INJURY $ 1 <br />000 <br /> , <br />,00( <br /> GENERAL AGGREGATE $ 3 <br />000 <br /> <br />. , <br />,00( <br /> GEN <br />L AGGREGATE LIMIT APPLIES PER: <br />PRO- PRODUCTS - COMP/OP AGG $ 1,000,00( <br /> POLICY <br />JECT LOC <br /> AU TOMOBILE LIABILITY PHPK528579 03/09/2010 03/09/2011 <br /> <br />X <br />ANY AUTO COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br /> 1,000,000 <br /> <br /> <br />A ALL OWNED AUTOS <br /> <br />SCHEDULED AUTOS <br />BODILY INJURY <br />(Per person) <br /> <br />$ <br /> X F <br /> <br />X HIRED AUTOS <br />NON-OWNED AUTOS ??qq <br />JP? Iro <br />- - <br />- BODILY INJURY <br />(Per accident) <br />$ <br /> <br /> <br /> E, ?f C?CK PROPERTY DAMAGE <br />(Per accident) $ <br /> GARAGE LIABILITY <br />Assists t City AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY <br />X PHUB298219 03/09/2010 03/09/2011 EACH OCCURRENCE $ 1, 000, 000 <br /> <br />B OCCUR CLAIMS MADE AGGREGATE $ <br /> $ 1,000,000 <br /> DEDUCTIBLE $ <br /> RETENTION $ <br /> WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY WC STATU- OTH- <br />JQRY LIMITS ER <br /> ANY PROPRIETOR/PARTNERlEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? E.L. EACI I ACCIDENT $ <br /> If yes, describe under E.L. DISEASE - EA EMPLOYEE $ <br /> <br /> <br />DESC SPECIAL PROVISIONS below <br />OTHER <br />RIPTION OP nDFAAT-. i I n E.L. DISEASE - POLICY LIMIT $ <br /> <br />_ <br />°txcept 10 days for non °' °1 icrv 1 ! At Cl IHL YKVVISIONS <br />payment of premium. Employee Dishonesty $200,000/$2,500 Ded. <br />'rofessional Liability $1,000,000 Each Occ/$3,000,000 Aggregate. City of Santa Ana <br />is named additional insured per contract with named insured. Schedule of vehicles <br />and drivers on file. "Non Profit organization" <br />City of Santa Ana <br />Community Development Agency <br />CDBG-M-25 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />ACORD 25 (2001108) FAX: (714) 571-1974 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL IXM MAIL <br />39" DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />A(J?KXsYdCD?D(n10rs?4?f?CD(dfd??6XIxXnX?61?KX?(Dd?A(?iX?XA6bEJGXXXX <br />IV= <br />©ACORD CORPORATION 1988