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JU"e-
<br />A�`b'r CERTIFICATE OF LIABILITY INSURANCE
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<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 aD ADDITIONAL INSURED, the policy(les) 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
<br />Lake Insurance Agency
<br />653 South B Street, Suite 200
<br />Lin #0747473
<br />Tustin CA 92780
<br />ON OANTA
<br />iE:CT Athena Stark
<br />PHONE (7141838-1912 �SA Noh (72A}R38-7 age
<br />ADDREs athena@lakeins, com
<br />INSURER(SI0.PFORD NG COVERAGE
<br />NAIV'M
<br />INSURERA:P_hiladelphia Indemnity Ins, Co.
<br />18058
<br />INSURED m
<br />II Orange County Children's Therapeutic
<br />Art Center, Inc,
<br />2215 N. Broadway
<br />Santa Ana CA 92706
<br />INSURER B:
<br />INSURER
<br />_
<br />INSURER O:
<br />INSURERE:
<br />INSURER F:Y
<br />IK�YIR:&[HX.�H�YII iN_ill�lllt141-7�:AIMOIK>• 'r.'ar`t•rrsaw I67:7�NAVA61IQ1LUllegW
<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 CR OTHER DOCUMENT WfTH 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 />IL,R
<br />TYPE OPINSURANCE
<br />IN aA
<br />POLICY-NUMBER
<br />POLICYeEEF
<br />NIIO
<br />VYO
<br />hiD�
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1, 000,000
<br />X COP.
<br />COMMERCIAL GENERAL LIABILITY
<br />A A
<br />PRERMISIS ETEES IEe occurrencal
<br />$ 1,000,00C
<br />A
<br />CLAIMS -MADE C_ilOCCUR
<br />PHPK947781
<br />2/21/2012
<br />2/21/2013
<br />MEDEAP(An ane person)
<br />$ 20,0000
<br />PERSONAL& ABV INJURY
<br />$ 1,000, 000
<br />GENERAL A,OGREGATE
<br />5 2,000,000
<br />GEN'L AGGREGATE 1111TAPPLIES PER:
<br />PRODUCTS-COMPIQP AGO
<br />S 2,000,0001
<br />$
<br />X POLICY PRO- LOG
<br />AUTOMOBILELIABILITP
<br />COMBINED SI GLF E LIMIT'
<br />a.ldant
<br />S l 000,400
<br />BODILY INJURY (Per person)
<br />S
<br />—
<br />A
<br />ANY AUTO
<br />ALLOWNED j SCHEDULED
<br />PHPK947781.
<br />2/21/2012
<br />2/21/2013
<br />COUILYiNJURY{Perw4d.flB
<br />S
<br />AUTOS ... AUTOS
<br />X X NON -OWNED
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<br />PROPERTY DAMJiGE
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<br />EXCESS HAS CLAIMS{MADE
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<br />AGGREGATE
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<br />OED RET N'fIONS
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<br />ANYPROPRIETORVARTN.ERtEXECUTiYE❑
<br />EL EACH ACGDENT
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<br />OFFICE TASKIBER EXCLUDED?.
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<br />(Mandatory to NH)
<br />E.L. DISEASEEAEktPLOYEE
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<br />Ify9s, ct.w he Under
<br />b E$CRIPTION OF OPERATIONS belay
<br />EL DISEASE -POLICY LIPAIT
<br />$
<br />A
<br />Professional Liability
<br />_
<br />PHPK947781^
<br />2/21/2012
<br />2/21/2013
<br />-mIISIMILEachlncltlent $2MIL Agg.
<br />Abuse & Molestation
<br />Included
<br />L rnit$25k Each lnddent $50k Agg,
<br />DESCRIPTION OF OPERATIONS! LOCATIONSI VEHICLES (Attach ACORD 101, Additional Remarks Sehe..IA, If mare.earn is reghhad)
<br />Re: Insured's operations under contract with Additional Insured; The City of Santa Ana, Its Officers,
<br />Agents,Employeas & Volunteers Representatives - WIA as Additional Insured per CG 20 26 07 04, Primary
<br />and Non -Contributory applies per PI-MANU-1(01/00) but Only in the Event of the Named Insured's Sole
<br />Negligence, as required by written contract with Named Insured.
<br />(714)565-2602 jcastro-cardenas@santa-ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />The City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Its Officers,Employees,Agents,Volunteers
<br />and Representatives - WIA AUTHORIZED REPRESENTATIVE
<br />Attn: Julie Castro -Cardenas
<br />1000 E Santa Ana Blvd #200
<br />Santa Ana, CA 92701 Bob Lake-C/L/ATHENA
<br />ACORD 26 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved.
<br />IN.9n2s romm"m Th. AnnRll Hama an.rf r f AnnPn
<br />
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