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PRODUCER (714)838-1912 <br />I -U., T--------- •_____. <br />CERTIFICATE IS ISSUED AS A MATTER OF INFO <br />ZA <br />THE PFTERM <br />INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY RT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH <br />L-1,rd� <br />AC W. CERTIFICATE OF LIABILITY <br />PROD LER (714)838-1912 FAX (714)838-7568 <br />Lake Insurance Agency <br />13891 Newport Ave., Suite 285 <br />Lit #0747473 <br />INSURANCE 12/20/D2010) <br />u/zo/zolo <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 />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE NAIL# <br />INSURER A Philadelphia Insurance Co. <br />Tustin, CA 92780 <br />INSURED Orange County Children's Therapeutic Art Cente <br />2215 N. Broadway <br />Santa Ana, CA 92706 <br />INSURER 8: <br />INSURER C' <br />POLICY EFFECTIVE <br />INSURER D: <br />LIMITS <br />INSURER E: <br />f:f1VFDAlsFC - <br />ABILITY <br />THE PFTERM <br />INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY RT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH <br />RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR <br />MAY PINSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO <br />ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR DD'PE <br />OF INSURANCE <br />POLICY EFFECTIVE <br />POLICY EXPIRATIONPOLICYNUMBER <br />LIMITS <br />ABILITY <br />PHPK651522 <br />12/21/2010 <br />12/21/2011 <br />EACH OCCURRENCE $ 1,000,000 <br />RCIALGENERALLIABILITY <br />DAMAGETORENTEO S <br />MADE � OCCUR <br />10000AIMS <br />A <br />MED EXP (Any ale Person) S 5,00( <br />PERSONAL&ADV INJURY $ 11000100 <br />GENERAL AGGREGATE S 2,000,00C <br />GEML AGGREGATE LIMITAPPLIES PER: <br />PRODUCTS-COMP/OPAGG S 2�QQQ QQ <br />POLICY PRO- <br />JECT LOG <br />. <br />AUTOMOBILE <br />LIABILITY <br />PHPK651522 <br />12/21/2010 <br />12/21/2011 <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ee Aaldent) S <br />ALL OWNED AUTOS <br />11 000 , OO <br />BODILY INJURY $ <br />person) <br />A <br />SCHEDULED AUTOS <br />X <br />HIRED AUTOS <br />BODILYINJURY $ <br />(Pe .a dwt) <br />X <br />NON-OWNEDAUTOS <br />.,q� <br />T OM <br />PROPERTYDAMAGE <br />$ <br />T(Pe, <br />ec Wt) <br />GARAGELIABILITY <br />ApBRO <br />NLY-Fq ACCIDENT $ <br />ANYY <br />^ <br />HAN EAACC $ <br />CK <br />LY. AGO $ <br />EXCESSNMBRELLA LlAB1UTY <br />❑ CLAIMSIVADE <br />W CAW <br />Or"my <br />CURRENCE $ <br />ATE S <br />p,ssistan <br />' <br />S <br />DEDUCTIBLE <br />,/ <br />9 <br />$ <br />*EMIPLOYES <br />RETENTION $ <br />/ <br />SWORI(ERS <br />AND <br />STATU- OTH- <br />ERV LIIBILITYION <br />EMPLOYEfl3' LIABILITYANY <br />PROPRIETORIPARTNEWEXECLiTIVE <br />EXCLUDED?Nyes,deacrlbe <br />ACCIDENT SOFFICERRJEMBER <br />ASE-EAEhIPLOYE SSPECIAL <br />under <br />PROVI31ON30 I. <br />Professional <br />PHPK651522 <br />12/21/2010 <br />ASE -POLICY LIM1IIT $ <br />Liability <br />12/21/2011 <br />Incident Limit: $1,000,000 <br />A <br />Aggregate Limit: $2,000,000 <br />DESCRIP ION OF OPERATIONS/LOCATIONS/ VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />ertitiicate holder is Additional Insured as per form CG2005 (11/85) <br />Abuse & Molestation is included with General Liability , $2S,000 Each 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 days for non-payment of premium <br />City of Santa Ana Community Developmen Agency <br />its Officers, Agents, Employees & Volunteers <br />Attn: Frank Hernandez <br />P 0 Box 1988 <br />Santa Ana, CA 92702 <br />AIn.n ne ,—.,.... <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />"30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT <br />BUT FAILURE TO MAR SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />OF ANY HIND UPON T)I4INSUREIZ ITS AGENTS OR REPRESENTATIVES. <br />AUTHORIZED REPRESE/TTAINII /. . / ',4-- .? <br />©ACORD CORPORATION 1988 <br />