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<br />'`'t,�°.� °' CERTIFICATE OF LIABILITY INSURANCE
<br />°ATE(M1 /JOD/YYY`n
<br />02/2A/11
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TH)S
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES hOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sj, AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If tho co Hl(laate holder is an AookTIONAL INSURED, the pollcy(las) niLlst be elldorsod. if SUBROGATION tS WAIVED, stll)Ject to
<br />the terms Rnd cwid ltlons of the policy, cerlaln pollclea may roqulre an endorsomont. A eta lemon[ on this certiticate does not confer rlDhts to the
<br />certiticate holder In IIetI of such eETdorso_ntonE s . _
<br />PRODUCER � 82B -4O$ -8031
<br />Chapman 820 -405 -0685
<br />License N0622024
<br />P. O. BOX 6465
<br />Pasadena, CA 91117 -0456
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<br />INSURB a AFF ORDt7f0 GOVERAQE
<br />t1AIC Y
<br />II+sURw Orangewood Childron's
<br />Foundation
<br />1676 E, 17th Street
<br />Santa Ana, CA 92706
<br />IwsuRERn:Non rofits' Insurance AI[lance
<br />10023
<br />HlsuaERa;EVerest National Insurance Co
<br />10120
<br />It1aVRERC,FidelFty &Deposit Co Maryland __
<br />38305
<br />msufteRO,Oroat American Insurance Co
<br />1G681
<br />1I19URER E
<br />$ 20,00
<br />1 SURER F
<br />_
<br />$ 1.000,00
<br />COVE RAC3E3 CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICES OF INSUfiANCE L}STED 6ELOW HAVE BEEN ISSUL'D TO THE INSURED NAMED ABOVE FOR TFiE POLICY PERIOD
<br />INOICATEO. NOTVNT HSTANDINO ANY REQUIREMENT, TERtt OR CONDITION OF ANY CONTRACT OR OTHER OOCUA(ENT 1MTH RESPECT TO WHICH THIS
<br />CERTIFICATE fJIAY BE ISSUED OR htAY PERTAIN, THE INSURANCE AF FORGED BY THE POLICIES DESC(31BED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUS {DNS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MIRY HAVE BEEN REDUCED BY PA]D CLAIl+IS-�
<br />1
<br />TYPE OF1+19URAHCB
<br />POLICY NU BE
<br />ME O
<br />LIIdIT3
<br />A
<br />GENEFIAL UASILITY
<br />X COhiME RCIAL GENE RAL LIABILITY
<br />CLAIMS MADE � OCCUR
<br />X Profesalo Rel LIAb
<br />X
<br />201 11 2 7 7 8NP0
<br />03!01111
<br />03!01!12
<br />EACI4 CCCV RRENCE
<br />S 1,000,UB
<br />° E�,II�q�F7 Eaa�E a
<br />$ GOO,OO
<br />MED EXP An one rson
<br />$ 20,00
<br />PERSO+LtI d AOV INIURY
<br />_
<br />$ 1.000,00
<br />X
<br />AOuaB Llanlllty
<br />GENERAL AGGii L "GATE
<br />$ 3,000,00
<br />OENL AGGREGATE
<br />POLICY
<br />LIAEIT APPLIkiS PER:
<br />P O- LOC
<br />PROOVCTS •COM PpP A00
<br />S 3,000.00
<br />$
<br />A
<br />AUTOFIOBILE
<br />LIAUILITY
<br />ANY AUro
<br />ALL OWNED AUTOS
<br />6CHE WLEO AVT03
<br />EIIRF.DAVT09
<br />NON -0WNEOAUT09
<br />2 0111 277 8NP0
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<br />T_� ^�II �v�Y
<br />03101!11
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<br />O ��},
<br />03f01l12
<br />CO!ABINED 911JGLE UREIT
<br />(Ee eocldanl)
<br />$ 1,000,00
<br />BODILY INJURY (Per pefaon)
<br />S
<br />BODILY INJURY (Per OtUdonl)
<br />S
<br />PROPERTY OMIAOE --
<br />(POfe WdenU
<br />S
<br />X
<br />X
<br />U /BBRELLA LIAB
<br />Excess LlAB
<br />OCCUR
<br />CLAIt.i S'LUDI'
<br />S.�
<br />`�ISA �'•
<br />psslstant Ctty
<br />R(j {`
<br />AttoxneY
<br />//
<br />�/
<br />EACH CCCVRRENCE
<br />3
<br />_
<br />AGGREGATE _
<br />s _
<br />_
<br />DEDUCTIBLE
<br />RETEMION S
<br />$
<br />S
<br />B
<br />\YORI(Efta COh1PENSA710N
<br />AIEOEMPLOYERS•LlABILI7Y yRf
<br />AN1 'PROPN£TOR/PARTNERIEXECUTIVE�
<br />OFFl CC-rVME7.IBER EXCLUDED?
<br />(tfmdalory In NH)
<br />If yes desMhe uMer
<br />DESCRIPTION OF OPERATIONS boiorr
<br />E17A
<br />0000001013111
<br />03 /01/11
<br />03/01712
<br />'C STA V-
<br />EA. etCH ACCIDENT
<br />$ 1,000,00
<br />E.L. DISEASE -EA EMPLOYE
<br />$ 1,000,00
<br />E.L. Dt9EASE - POLICY LI7.11T
<br />$ 1,000,00
<br />C
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<br />CrlR10 Covora9u
<br />Proporly Covora£le
<br />CCP00818e8e6
<br />PAC7676S480b
<br />02/01!11
<br />03lofl1l
<br />02lOiN2
<br />03101/12
<br />Blk! Cont 66a,00
<br />Empt Dlah 600,00
<br />DESCRIPRON OF OPERATIONS/ LOCATIDN3! VENICLE9 (Allath ACORO 101, Addlllonal Re,narko bchedulo, 11 mono apace Is required)
<br />Tlio Clty of Santa Arta, It's of(Icers empptoyoes, aDelTte, voluliteera and
<br />rep reaentalives aro Hamad as an dddillonal lnaured as resPecta uabmty
<br />arlslnD from the oporatlona of the named lnaured per the attached CG 2028
<br />endorsement. Workers compensation coveraDe ezciuded, oVldenco only.
<br />L:bK I11'IGAI t IYVLV tit vNIViCI -LH 1I�IV _
<br />CITYSAN
<br />SHOULD ANY OP THE ABOVE DE3C RIBEO pOLIC l68 BE CANCELLED BEPORE
<br />THE EXPIRATION PATE THEREOF, NOTICE WILL BE OE LIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROV)S[O N8.
<br />20 Civic Celttar Plaza -
<br />Santa Ana, CA 92701 AUT KORI2ED REPRESENTATNE
<br />� 1988 -2000 ACORD CORPORATION. All rinlTta reserved.
<br />ACORD 26 (2009/00) The ACORD namo and l00o are reDlatered marks of ACORD
<br />
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