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<br />,4? °® CERTIFICATE OF LIABILITY INSURANCE X2/29/2011 <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 CONTACT Brian Okumura <br />NAME: <br />Advantis Insurance Services PHONE (949)545-0220 FAX, <br />(AIC N (949) 595-0221 <br />26522 La Alameda ED-MAILDRESbrian@advantisins.com <br />A <br />Suite 210 INSURERS AFFORDING COVERAGE NAIC # <br />Mission Viejo CA 92691-8586 INSURERA:Travelers <br />INSURED INSURER B : <br />Orange County Association for Mental Health, INSURERC: <br />822 W. Town and Country Road INSURERD: <br /> INSURER E : <br />Orange CA 92668 INSURER F: <br />COVERAGES CERTIFICATE NUMBER:CL11122902147 REVISION NUMBER: <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 THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR TYPE OF INSURANCE <br />1BAEL <br />POLICY NUMBER POLICY EFF <br />MM/DD/YYYY POLICY EXP <br />MM/DD LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMA RENTED <br /> COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) <br />$ <br /> <br /> CLAIMS-MADE F? OCCUR MED EXP (Any one person) $ <br /> PERSONAL & ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ <br /> POLICY PRO- LOC <br />JECT $ <br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Fa accident <br /> ANY AUTO BODILY INJURY (Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per accident <br /> <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR H CLAJMS-MADE AGGREGATE $ <br /> DED RETENTION $ $ <br />A WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY WC STATU- OTH- <br /> Y / N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br />? <br />N I A E.L. EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? <br />(Mandatory In NH) 3524T36111 8/1/2011 8/1/2012 E.L. DISEASE - EA EMPLOYE $ 11000,000 <br /> If yes, describe under <br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 11000,000 <br /> <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Certificate holder is named as additional insured. <br />\.CK I IrmiAir r1VLUCK <br />City of Santa Ana <br />Community Development Agency <br />20 Civic Center Plz M25 <br />Santa Ana, CA 92701-4058 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Brian Okumura/SERVCEl ::> <br />ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. <br />INS025 mmnnri nt Tho AnORn name and Inns aro roni?lorurl m-rk¢ of Ar-ORn