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<br />07/26/2012 17:59 FAX <br />ACCRD <br />'lV <br /> <br />14I 000210003 <br /> <br />PRODUCER 714 838.1912 <br />Lake Insu ance Agency <br />653 South ~ Street, Suite 200 <br />~. #07474f3 <br />., in, CAI92780 <br />INSUReD Orang! County Children's <br />2215 ~. Broadway <br />Santa (Ana, CA 92706 <br /> <br />FAX 714.838.7568 <br /> <br />I . DATE IMMIDD/Y'1YY) <br />01/13/2012 <br />THIS CERTIFICATE IS ISSUED AS A MAT ER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON HE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AA'END, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY HE POLICIES BELOW. <br /> <br />CERTIFICATE OF LIABILITY INSURANCE <br /> <br />Therapeutlc <br /> <br />INSURERS AFFORDING COVERAGE <br /> <br />Art Center INSURER A: Philadelphia Insurance C . <br />INSURER s: <br />INSURER c: <br /> <br />HAle # <br /> <br />I <br /> <br />COVERAGES I <br /> <br />THE POLICIes qF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IN[ ICATED. NOTWITHSTANDING <br />ANY REQUIREMJ:NT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFlc. TE MAY BE ISSUED OR <br />MAY PERTAIN, 1HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AlL THE TERMS, EXCLUSIONS NO CONDITIONS OF SUCH <br />POLICIES. AGGF EGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlO CI.AJMS. <br /> <br />.~ ~o.l~~ rYPE OF INSURANCE POLICY NUMBER ~~Y El'FECl'1VE POUCY EXPIRATION UMlTS <br /> <br />GENERAl UABlUTY PHPK794249 12/21/2011 12/21/2012 EACH OCCURRENC $ <br />- <br />X cor. I/IERCIAL GENERAl. LIABILITY DAMAGE TO RENT< P $ <br />I CLAIMS MADE 00 OCCUR MED EXP (Any one ~ ~~ $ <br />PERSONAL & ADV I URY $ <br />GENERAlAGGREG TE $ <br />Pl<ODUCTS - COMP P AQG $ <br /> <br />INSURER D' <br />INSURER E; <br /> <br />A <br /> <br />GEN'L AG !;REGATE LIMIT APPLIES PER: <br />I POLl Y n ~m fXll..OC <br />AUTOMOE LE L.lABJUTY <br />- <br />AN'( UTO <br />--- <br />All ( WNED AUTOS <br />--- <br />SCH pULEO AUTOS <br />I-- <br />X HIRE! AUTOS <br />f-- <br />X NON- WNED AUTOS <br />r-- <br />'---- <br /> <br />l,Ooo,OO€l <br />lOO,OO(] <br />5,OO<<J <br />1 OOO,oo(J <br />2,000,000 <br />2,ooO.00Cl <br /> <br />A <br /> <br />PHPK794249 12/21/2011 <br /> <br />12/21/2012 <br /> <br />COMBINED SINGLE !MIT <br />(Ea accident) <br /> <br />$ <br /> <br />1,000,000 <br /> <br />BOOII.. Y INJURY <br />(Per p8r30n) <br /> <br />$ <br /> <br />BODII.. Y INJURY <br />(Per ac:eidenl) <br /> <br />$ <br /> <br />PROPERTY DAMAGE <br />(Per accident) <br /> <br />$ <br /> <br />GARAGE 1. ABlUTY <br />R A~,UTO <br /> <br />EXCESSIU 8REU.A UABlUTY <br />=:J OCCU 0 Cl..AlMS MADE <br /> <br /> <br />I DEDU T1BLE <br /> <br />I RETE nON $ <br /> <br />WORKERS COM~ HSA110N AND <br />EMPLOYERS" UAI IUTY <br />AN'( PROPRIETO ~ARTNERlEXECU1lVE <br />OEECERlMEMSE EXCLUDED? -. <br />If yes, describe UIlC I!r <br />SPECIAL ?ROVlS NS below <br /> <br />pO~1ression 1 Liability <br />r\ <br /> <br />AUTO ONLY. EA AC( DENT $ <br /> <br />OTHER THAN :A ACe $ <br />AUTO ONLY: AGG $ <br /> <br />EACH OCCURRENCE $ <br /> <br />AGGREGATE <br /> <br />$ <br />$ <br />$ <br />$ <br /> <br />.. <br /> <br />I WCSTATU- I IOJit <br /> <br />E.L.. EACH ACCIDENT $ <br />E.L. SISEASE--eA EM L~e $ <br />E.l.. DISEASE. POwe' LIMrr $ <br />Incident L mit: $1,000,000. <br />Aggregate imit: $2,000,000 <br /> <br />PHPK794249 12/21/2011 12/21/2012 <br /> <br />ESCRIPllON OF O~ TIONS I LOCATIONS I VEHICLES I EXCl.USlONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />!rtificate h(]lder't is Additional Insured as per form CG 20 26 07 04 Attached <br />Juse 81 Molestation is included with General Liability, $25,000 Each Incident and $50,O)() Aggregate <br />lis Insurance Shall be Primary and Non-Contributory but Only in the Event of the Named <br />Isured's Sole Negligence per attached endorsement APPIIOVEDA~TOFORM <br />:xcept 10 Day 5 Notice of Cancellation for Non-Payment of prenrium \ rc 1\ <br /> <br />C....C..-.L. "T"I--' ' . .J,-;;7.... ~- <br />ERTIFICATE HO .DER .AN' .J::.l.LA I IUN .....--- <br />\ SHOULD AN'{ OF THE ABOVE BE CAl cE\e..sD BEFORE THE <br />City of Santa Ana Police Athletics EXPlRA~NDATEntEREOF,nteISSUI~G~~ .7 TOIlAlL <br />,,---.... a. nd AC$.vities league, Its Officers EJq:Jloyee *30 DAYSWRlTTENNoncnont OTHEl..EFT <br />Agents 1 unteers & Representatives -" ' <br />Attn: T Serafin BUTFAlLURETOMAlLS_~ A .'." ..~"iT1ONOfUlASlUTY <br />2627 Wes~ McFadden Street OF AN'{ KINO UPON TltEJ;Ju-" R.! !NTATlVES. <br />Santa Ana, CA 92704 AUTHORIZED REflRESEN~ _ 7 In.-L A .II{ <br />r 'OIVf/W v (/'- <br /> <br />::ORD 25 (2001/0 ) @ACO D CORPORATION 1988 <br />