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I <br />.D-0Mu CERTIFICATE OF LIABILITY INSURANCE 06/13/2011 <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 />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />13891 Newport Ave., Suite 285 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Lic #0747473 <br />Tustin, CA 92 780 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED Orange County Children's Therapeutic Art Center INSURERA Philadelphia Insurance Co. <br />2215 N. Broadway INSURER 0: <br />Santa Ana, CA 92706 INSURER C: <br />INSURER D: <br />INSURER E: <br />COVERAGES <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 BYTHE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.. <br />INSR <br />I TRIM <br />DO' <br />TYPE OF INSURANCE <br />POLICY NUAM1BER <br />POLPCDATEY EPFECTiV£ <br />12/21/2010 <br />POLICY EXPIRATION <br />12/21/2011 <br />LIMITS <br />GENERALUABILITY <br />PHPK6515Z2 <br />EACH OCCURRENCE $ 1,000,000 <br />DAMAGE TO RENTED $ 100,000 <br />X CONWERCIALGENERAL LIABILITY <br />MED EXP (Any one person) $ 5,00 <br />CLAIMS MADE a OCCUR <br />PERSONAL. &ADV INJURY $ 1,000,000 <br />A <br />OENERALAGGREOATE $ 2,000,000 <br />GEN'LAGGREGATE LIMrTAPPLIES PER: <br />PRODUCTS-COMPIOPAGG $ 21000,000 <br />POLICYF_j PRCT O- LOC <br />JE <br />AUTOMOBILE LIABILITY <br />PHPK651522 <br />12/21/2010 <br />12/21/2011 <br />COMBINED SINGLE LIMIT $ <br />ANY AUTO <br />(Ea accldenl) 1,000,000 <br />BODILY INJURY $ <br />ALLOWNEDAUTOS <br />A <br />SCHEDULED AUTOS <br />(Per Person) <br />X HIRED AUTOS <br />BODILY INJURY $ <br />X NON-OWNEDAUTOS <br />APPROVED <br />AS TO FORM <br />(Per accident) <br />PROPERTY DAMAGE $ <br />/V --- <br />(Per accident) <br />GARAGE LIABILITY <br />` <br />AUTO ONLY - EA ACCIDENT $ <br />OTHERTxAN EA ACC $ <br />ANYAUTO <br />LISA <br />E.. STORCK <br />Assistar <br />t CitVAttorn <br />_v <br />AUTO ONLY: AGG $ <br />EXCESSIUMBRELLA LIABILITY <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />OCCUR � CLAIMS MADE <br />S <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />WORKERS COMPENSATION AND <br />TH <br />WC STATU- FR <br />E,L, EACH ACCIDENT $ <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNEWEXECUTIVE <br />E.L. DISEASE - EA EMPLOYEE $ <br />OFFICER/MEMBER EXCLUDED? <br />Des, descae under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE - POLICY LVArr $ <br />OTx <br />PHPK651522 <br />12/21/2010 <br />12/21/2011 <br />Incident Limit: $1,000,000 <br />A <br />Professional Liability <br />Aggregate Limit: $2,000,000 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES I ExCLUS ONS ADDED BY ENDORSEMENT I SPECIAL P OVISIONS <br />ertificate Holder is Named as AYt_ oval Insured per Form CG02005 (11/85) Attached <br />Buse & Molestation is included with General Liability , $25,000 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 <br />°Except 10 Days Notice of Cancellation for Non -Payment of Premium <br />The City of Santa Ana <br />Its Officers, Employees, Agents & Volunteers <br />Attn: Julie Castro=Cardenas <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />SHOULD ANY OPTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />f130 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMEO TO THE LEFT, <br />BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />OF ANY KIND UPON THE IMARER, ITS AGENTS ORNPRESENTATIVES, <br />AUTHORIZED REPRESENTATI}v 1) }, <br />ACORD 26 (2001108) rru: ki1000 <br />