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0 i OP ID: SH
<br />'4 °- CERTIFICATE OF LIABILITY INSURANCE DAT
<br />DIYYYY)
<br /> 1
<br />0/10
<br />10/10111
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER 949-253-8000
<br />F
<br />i CONTACT
<br />NAME: Shelly Hehner
<br />r
<br />edmann & Friedmann Ins Svcs
<br />CA License #0759373 949-253-8009 PHONE
<br />WC, N Ezt): 949-417-2641 _ Ja No): 949-253-8009
<br />3990 Westerly Place Suite 100
<br />E-MAIL
<br />ADDRESS: shelly@fandfins.com
<br />Newport Beach, CA 92660
<br />Laverne Friedmann PRODUCER LAURA-1
<br />CUSTOMER ID #:
<br /> INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED Laura's House INSURER A: Philadelphia Indemnity Ins. Co 18058
<br />999 Corporate Drive, Suite 225 --
<br />
<br />Ladera Ranch, CA 92694 INSURER B
<br /> INSURER C
<br /> INSURER D :
<br /> INSURER E :
<br /> INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NIIMFIFR-
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL T HE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR TYPE OF INSURANCE A Li1111 .
<br />LTR. POLICY NUMBER '.. POLICY EFF POLICY EXP ? -- --
<br />MM/DD/YYYY - MM/DD/YYYY '. LIMITS
<br />GENERAL LIABILITY EACH OCCURRENCE 1,000,000
<br />
<br />A X I COMMERCIAL GENERAL LIABILITY X PHPK761643
<br />r- --....-
<br />10!11/11 10!11/12_
<br />PREMISES Ea occurrence $
<br />
<br />100,000
<br />CLAIMS-
<br />MADE
<br />1 11 -
<br />X I OCCUR _
<br />ME D P (Any one person $
<br />) 10,000
<br />ro essional
<br />Liab
<br />?
<br />A X
<br />$3,000,0001$1,000,000 _
<br />
<br />10/11/11 10/11/12 i PERSONAL 8 ADV INJURY $
<br />~
<br />-
<br />1,000,000
<br />A X Sexual/Ph s Abuse - $1,000,000 / $1,000'000 10/11/11 10/11/12
<br />I _ $
<br />GENERAL AGGREGATE I 3,000,000
<br />
<br />GENL AGGREGATE LIMIT APPLIES PER I
<br />
<br />PRODUCTS - COMP/OP AGG $
<br />
<br />3,000,000
<br />O C PRO
<br />
<br />
<br />P BLOC I
<br />7 r
<br />?-
<br />
<br />'$
<br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br />$
<br />000
<br />000
<br />1
<br />A CX? ANY AUTO
<br />PHPK761643 (Ea accident)
<br />10/11/11 10/11/12 ----- -- --- ,
<br />,
<br />- - - --
<br /> BODILY INJURY (Per person) $
<br />ALL OWNED AUTOS ------ ------
<br />' -- BODILY INJURY (Per accident) '. S
<br />SCHEDULED AUTOS
<br />
<br />HIRED AUTOS PHPK761643 PROPERTY DAMAGE
<br />I 10/11/11 10/11112 (Per accident) $
<br />r
<br />A X
<br />NON-owNEDRUTOS IPHPK761643 -
<br />10/11/11 10/11/12 $ -- -
<br /> $
<br />UMBRELLA LIAR i i ,
<br />___ X 'OCCUR ''i '
<br />EACH OCCURRENCE $
<br />1,000,000
<br />EXCESS LIAB ! CLAIMS-MADE
<br />,
<br />A iPHUB356425 T
<br />$
<br />10/11/11 10/11/12 AGGREGATE
<br />- - --- ---
<br />
<br />11000,000
<br />-- -
<br />_ DEDUCTIBLE $
<br />
<br />
<br />X
<br />RETENTION $ 10,000 1
<br />
<br />
<br />--
<br />_-- - -_ - --
<br />i
<br />$ -- --
<br />-
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY WC STATU- OTH-
<br />TORY LIMITS ER
<br />YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? ? N IA .L. EACH ACCIDENT $
<br />E
<br />(Mandatory in NH)
<br />I'
<br />If
<br />es
<br />describe under !
<br />' E.L. DID SEASE - EA EMPLOYEE. $
<br />!
<br />,
<br />,
<br />y
<br />. DESCRIPTION OF OPERATIONS below -
<br />E.L. DISEASE- POLICY LIMIT $ - --
<br />A Crime PHPK761643 10/11!11 10/11/12 ;Emp Theft 200,00
<br />I Forgery 200,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />The City of Santa Ana Community Development Department M-25, its officers
<br />'to
<br />,
<br />employees, volunteers, agents and representatives are included as Additional ED AS
<br />Insured per wording incorporated into the policy forms. V
<br />RE: Community Development Block Grant gvs
<br /> K
<br />Ilk-
<br />Ct:K I IFIGATE HOLDER CANCELLATION I/_lU/`` E, i
<br />City of Santa Ana Community
<br />Development Department M-25
<br />20 Civic Center Plaza, 6th FI
<br />Santa Ana, CA 92701
<br />ACORD 25 (2009/09)
<br />CITYS-8 ??" `''`aaf?t G?ty
<br />SHOULD ANY OF THE ABOVE DESCRILICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AU,{TQjH/O' RIZEND//REEPRESENTATIVE
<br />© 1988-2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />J(
<br />t)re.
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