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6!2/2010 13:53 PH FACM: 619-224-5360 TO: +1 (714) 6476E49 PAGE: 00-, -.-F
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<br />^s"Is?s?yi-I?;;?;?jya DATE (MP,VDDJYY)..
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<br />0512012010
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<br />RODUCER Serial # 100221 THIS CERTIFICATE IS ISSUED AS A MATTER
<br />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 IOLICIES BELOW.
<br />SAN DIEGO, CA 92167 COMPANIES AFFORDING COVERAGE
<br />619-222-4458
<br />COY!PANY
<br />PHILADELPHIA INDEMNITY INSUR. ONCE CO
<br />A
<br />.
<br />JSURED W.A.PA.NY -? -- --------------
<br />LATINO HEALTH ACCESS B
<br />1701 N NAIN ST.
<br />SANTA ANA, CA 92706 COMPANY
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<br />COMPANY
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<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THI: POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM CR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTWITH RESPEC r TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUEDOR MAY PERTAIN, THE INSURANCE AFFORDED B Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE. TERMS.
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />O TYPE OF INSURANCE
<br />•R POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
<br />DATE(MMTDOWY) DATE(MKMDrYY)
<br />GE NERAL LIABILITY PHPK570311 05!2012010 05/20/2011 GENkR1LAGGREGATE 1000000
<br />1, X COPJ7'ERCIAL rE17ERAL LIABI.TTY PRODUCTS, CC` APA:P A(3 S 1000000
<br /> CLAIMSMADE X OCCUR PSRSOf7FL SAD': iNnJR` 1000000
<br /> C'.VNER8&CONTk7ACTCRS PROT E4CH000URRENCE 5 1000000
<br /> FIRE DAMAGE (Any cnr %,,) S 100000
<br /> r1EUEXP (An oneporsa, , 5000
<br />AU TOMOBILE LIABILITY PHPK570311 0512012010 0512012011
<br />1, X ANY AUTO COa!BIflEDSfCGLEL1•T S 100000c
<br /> ALL OWNED AUTOS
<br /> BCd.LYINJUR'! 5
<br /> SCHEDULED AUTOS (Par Parson!
<br />X HIREDAU70S g? ----_ --- ------
<br /> L? ECIY.LYiNJURY $
<br />X NON-OWNED AUTOS (
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<br />GARAGE w9 LIABILITY
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<br />EXCESS LIABILITY EACH OC CURRENC.F S
<br />UMBRELLA FORM A03REG.ATE s
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<br />OTHER THAI1 UP/BRELLA FOR" S ^ l
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<br />WORKER'S CMPENSATICN AND we srATlL 0'
<br />TORYLIVRS i
<br />EMPLOYERS! LIABILITY _
<br /> EL EACH ACCIDENT 5
<br />TFE PROPRIETOi/
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<br />PrA%'n-ffisexearrT1E L ---"
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<br />ELO:SEASE-POLIGI'Uf/I S
<br />OFFICERS ARP EXCL EL D:SEASE - EA EW! L01 -E S
<br />OTHER
<br />EWRIPTION OFOPER4TIONSILOCATIONSNEHICLESISPEC!AL ITEMS
<br />ITY OF SANTAANA ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS IS NAMED ADDITIONAL INSURED PER CG00011207
<br />ND CG20051185 (ATTACHED)
<br /> SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CaPICELLED BEFORE THE
<br />CITY OF SANTA ANA EXPIRATION DATE THEREOF, THE ISSUING COMPANY WIL _ EN66Q&M MAIL
<br />20 CIVIC CENTER PLAZA, K21 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDS i NAMED TO THE LEFT,
<br />SANTA ANA, CA 92701
<br /> lJ8HY0430?0
<br />AUTHORVE0 R?=P
<br />RESSENTATIVE BLAKEMORE& ASSOCIATES
<br />--------------- - ??
<br />tFMPRO',CERTPROS LATINOHEALTHACCESS.FPS
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