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DATE (MMRIDlYYY't) <br />ACORD,_. CERTIFICATE' OF LIABILITY INSURAIS"E 01/13/2012 <br />PRODUCER 714, 838.1912 FAX 714.638.756 THIS CERTIFICATE IS IziSUED AS A MATTER OF INFORMATION <br />Lake Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE . <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />653 South B Street, Suite 200 <br />Lic #0747473 <br />Tustin, CA 92780 <br />INsuRED Orange County C ldren's Therapeutic Art Center <br />2215 N. Broadway <br />Santa Ana, CA 92706 <br />INSURERS AFFORDING COVERAGE t NAIC # <br />INSURER/: Philadelphia Insurance Co. <br />INSURER B: <br />INSURER C: <br />INSURER 0: <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 />REDUCED BY PAID CLAIMS. POLI SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />MAY E8 AG, THE INSURANCE <br />POLICIES. N EU L M C AFFORDED BY THE <br />INSR <br />A <br />DD' <br />TYPE OF INSURANCE <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE�X OCCUR <br />POIJCY NUMBER <br />PHPK794249 <br />POLICY EFFECTNE <br />12/21/2011 <br />LICY E%PiRATION <br />PODATE 1MInOrMM_ <br />12/21/2012 <br />LIMITS <br />EACH OCCURRENCE S 1,000,0001 <br />DAMAGE TO RENTED s 100,00 <br />S180 EXP (Any one person) S 5 .00 <br />PERSONAL 3 ADV INJURY S 1,000-1000 <br />GENERAL AGGREGATE $ 21000,000 <br />PRODUCTS • COMPlOP AGG S 2,000,000 <br />GEML AGGREGATE LIMIT APPLIES PER <br />POLICY JECT X LOC <br />• <br />AUTOMOBILE <br />LIABILITY <br />PHPK794249 <br />12/21/2011 <br />12/21/2012 <br />COMBINED SINGLE LIMIT $ <br />(Ea �ldenq I.,0_00,000 <br />ANY AUTO <br />ALL OWNED AUTOS <br />{�(( <br />BODILY INJURY S <br />(P�� ) <br />A <br />X <br />SCHEOULEDAUT08 <br />HIRED AUTOS <br />�+ <br />AS yO <br />5 <br />0�+" <br />BODILLYINJURY S <br />X <br />NON-OWNEDAUTOS <br />/t <br />ApYg0 <br />{ ljt R <br />, <br />y <br />DAMAGE <br />{Por ecccROEdent) S <br />GARAGE LIABILITY <br />ANY AUTO <br />L� Clty Ate <br />ASsxstarit <br />AUTO ONLY-EAACCIDE14T S <br />OTHE ONHLYA.` EA ACC S <br />AUTOAGG $ <br />EXCESSIUMBRELLA LIABILITY <br />OCCUR CLAIMS MADE <br />• <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />S <br />S <br />DEDUCTIBLE <br />RETENTION S <br />S <br />WC STATU- OTH- <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />_ __- _ <br />- <br />E.L. EACH ACCIDENT - S_ <br />E.L.DISEASE - EA EMPLOYE $ <br />ANY PROPRIETORIPARTNERJEXECUTIVE <br />ANY <br />OFFICERIMEMBER EXCLUDED? <br />E.L. DISEASE - POLICY LIMIT S <br />Incident Limit: $1,000,000. <br />Aggregate Limit: $2,000,000 <br />A <br />if s describe under - <br />SPECIAL PROVISIONS below <br />oTo <br />roessional Liability <br />PHPK794249 <br />12/21/2011 <br />12/21/2012 <br />DESC PT' ONOFOPERA IONS /L4cnTIONS /V HICLESIE%CLUSONS DEDBYENDO BEMENTISPECIALPROY1310NS <br />ert�fTcate FHoilder is Named as Addit ona�l Insured per Form CG 20 26.07 04 Attached < <br />Buse & Molestation is included with General Liability , $251000 Each Incident and $50,000 Aggregate <br />This Insurance Shall be Primary and Non -Contributory but Only in the Event of the Named <br />nsured's Sole Negligence per Attached Endorsement <br />Except 10 Days Notice of Cancellation for Non -Payment of Premium <br />- It- LUC <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />The City of Santa Ana EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />Its Officers, Employees, Agents, Volunteers *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />and Representatives - WIA BUT FAILURE TO MAIL SUCH NOTICE HALLIMPOSF.NQjOSLI04710NRLLOMILrfY <br />Attn: Julie Castro -Cardenas <br />1000 E Santa Ana Blvd #200 OF ANY KIND UPON THE INSURER, S NTS R R P A <br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE / <br />ACORD 25 (2001 jos) FAX. 714.565.1601 <br />VJMVVRV VVf�!-vI V'�i.v.� .vv. <br />V <br />