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ACD -RD. CERTIFICATE' 7F LIABILITY INSURANP—E oziiiz012 <br />PRODUCER 714.838.1912 FAX 714.638. 7568 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Lake Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />653 South B Street, Suite 200 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Lic #0747473 <br />Tustin, CA 92780 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED Orange County Children's Therapeutic Art Centet INSURERA Philadelphia Insurance Co. <br />2215 N. Broadway INSURER B: <br />Santa Ana, CA 92706 INSURER C: <br />INSURER 0: <br />INSURER E: <br />I <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TAE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS 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 />AWL <br />nmDATE <br />TYPE OF INSURANCE <br />POUCY NUMBER <br />POLICY EFFECTIVE <br />POLICY EXPIRATION <br />IMWIIDMft <br />LIMITS <br />-LIL <br />GENERAL LIABILITY <br />PHPK794249 <br />12/21/2011 <br />12/21/2012 <br />EACH OCCURRENCE $ 1110005000 <br />X COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED $ 100,000 <br />CLAIMS MADE I OCCUR <br />MED EXP (Any one person) $ S1000 <br />A <br />PERSONAL & ADV INJURY $ 1,000,000 <br />GENERAL AGGREGATE $ 21000,000 <br />GERLACGREGATELIMIT APPLIES PER: <br />PRODUCTS -COMPIOPAGG $ 2,000,000 <br />POLICY EJ jEOT FX7 LOC <br />• <br />AUTOMOBILE <br />LIABIUTY <br />ANY AUTO <br />PHPK794249 <br />12/21/2011 <br />12/21/2012 <br />COMBINED SINGLE LIMIT <br />(Ea aoddent) $ 1,000,000 <br />BODILY INJURY <br />(Perperson) $ <br />A <br />X <br />X <br />RLL OWNEOAUTOS <br />SCHEDULEOAUTOS <br />HIRED AUTOS <br />NON-OWNEDAUTOS <br />r�+ <br />��' lO <br />YA0-4 /t <br />l/t <br />1 pR <br />O 10 <br />K <br />BODILY INJURY $ <br />(Per accident) <br />PROPERTY addnt) AGE S <br />GARAGE LIABILITY <br />A� <br />C,�� <br />O <br />AUTO ONLY - EA ACCIDENT $ <br />EA ACC $ <br />AU o ONLY AGG $ <br />ANY AUTO <br />ASS �S t8n� <br />EXCESS/UMBRELLALIABIUTY <br />EACH OCCURRENCE $ <br />OCCUR FI CLAIMS MADE <br />AGGREGATE $ <br />- <br />$ <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION S <br />WORKERS COMPENSATION AND <br />WC STATU- I OTH- <br />ITORYLIMITS FR <br />EMPLOYERS' LUABILM <br />ANY PROPRIETORIPARTNEFUEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />E.L.EACH ACCIDENT S <br />E.L. DISEASE - EA EMPLOYE $ <br />If yu, describe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE - POLICY UMIT I $ <br />A <br />roressional Liability <br />PHPK794249 <br />12/21/2011 <br />12/21/2012 <br />Incident Limit: $1,000,000, <br />Aggregate Limit: $2,000,000 <br />DESCR PTION OP OPERA IONS 1l4caTIONS/ HICLES 1 E CLUSIONS ADDED BY ENDO SEMENT/ SPECIAL PROVISIONS <br />ert-�ficate Holder is Name as Additional Insured per Form CG 20 26.07 04 Attached } <br />use & 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 per Attached Endorsement <br />Except 10 Days Notice of Cancellation for Non -Payment of Premium <br />LU <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />The City of Santa Ana EXPIRATION DATE THEREOF, THE ISSUING INSURERWILL ENDEAVOR TO MAIL <br />Its Officers, Employees, Agents, Volunteers !30 DAYSWRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />and Representatives - WIA <br />Attn: Julie Castro -Cardenas BUT FAILURE TO MAIL SUCH NOVOE,HALL IMPOSENQOBLIG47IO, TOR LIABILITY <br />1000 E Santa Ana Blvd #200 OF ANY KIND UPC CANTSJOR RIPRJAA <br />Santa Ana, CA 92701 AUTHORIZEDREPRESENTATIVE <br />ACORD 25 (2001108) FAX: 714.565.2602 (DACORD CORPORATION 1988 <br />