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<br />AC61?hp CERTIFICATE OF LIABILITY INSURANCE DATE t d,,01)
<br />��' 1/16/2013
<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 NFQATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
<br />I IMPORTANT: If the certificate Holder is an ADDITIONAL INSURED, the polfcy(Ies) most be ondorsod. If SUBROGATION IS WAIVED, subject to
<br />the torms and conditions of the policy, certain pclicles :nay require an ondorsernent. A statement on this certificate does not confor rights to the
<br />Certificate holder In Iles of such endorsementIs).
<br />PRODUCER
<br />Lake Insurance Agency
<br />CONTACT Athena Stark
<br />PHONE ............._.._._.
<br />-oiElaX,. (714)838-1912 (714i OJ e=1JGQ
<br />jppQES ;athena@lakeins, com
<br />653 South H Street, Suite 200
<br />INSURER I, COVE RAGE
<br />RAN)9
<br />Lic #0747473
<br />S3suRERA,PIjilade 1phia Indemnity Ins. Co.
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<br />18056_,_
<br />Tustin CA 92780
<br />PlSVRke
<br />INSURER H :
<br />Orange County Children's Therapeutic
<br />INSURER G;
<br />Art Center, Inc.
<br />INSURER E: .� ._ .__
<br />..._.._.._
<br />2215 N. Broadway
<br />Santa Ana CA 92706
<br />suRERF:,,,,,,,,,,,_„_„_„„
<br />COVERAGES CERTIFICATE NUMBER112-13 Pkg & Prof.Liab, REVISION NUMBER: _
<br />THIS 113 l'O CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INCICATED. NCT WTHSTANDING ANY REQUIREMENT, 'PERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VIMICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNIS,
<br />EX(AUSMNS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
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<br />Li TYPE OF INSURANCE
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<br />GENERALLIA67UTY
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<br />A CtAIidSMAO@ OCCUR
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<br />YTIPX997781 2i2LjP01212/21/2013
<br />GGK OCCURRSN
<br />$ Z OOQ,a00
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<br />MEO FXP {AaY ono P¢rsonl
<br />S__,_, Z 000,000
<br />_S _ _ 20,0000
<br />PERSONAL EAOVINJURT
<br />, 11000, 000
<br />GENERAL AGGREGATE
<br />& 2,000,000
<br />0FN'1.AG<iREGATE LIMU'APPLIES PFR
<br />PRDUUDI'6-CG11PlOP ACG
<br />S 2,000,000
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<br />AUTOMOBILE LIABILITY
<br />A ANYAUTD
<br />ALL ONMED SCHEDULED
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<br />NOY CANED
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<br />FI GISFASE POLICY LINVC
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<br />A Professional Liability
<br />HP&9411761 12/21/2012
<br />2/21/2013
<br />LfiB:51111L Earh lncidarl
<br />$21IIIL Agg.
<br />Abuse & Molestation
<br />xnaludod
<br />LI¢w$25% Each lcalde,d
<br />$50k Agg.
<br />OE6CRIPnI'1N DP DPERAnO1J9I LOCAnONS I VEHICLES (AQl,NI ACOP.D 101, Addlllonal Remarks ech<dw, If mor¢ space N (a pulrad)
<br />'Re: Inaured's operations under contract with Additional Insured; The City of Santa Ana, Its Officers,
<br />Agentn,Gmployees & Volunteers Representatives - WIA as Additional Insured per CG 20 26 07 04, Primary
<br />and Non -Contributory applies For P4-MANU-1(01/00) but Only in the Event of the .tamed Insured's Sole
<br />Negligence, as required by written contract with Named Insured.
<br />(714)$65-2602 jcastro-cavdenas@santa-ana
<br />The City of Santa Ana
<br />Its Officers,Employees,Agerlts,Vol.unteers
<br />and Representatives - WIA
<br />Attn: Julie Castro -Cardenas
<br />1.000 G Santa Ana Blvd $200
<br />Santa Ana, CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLER BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE IA/Mid THE POLICY PROVISIONS,
<br />AUTnORIZEOREPREsh.4TArVE
<br />0199II 200 ACORD CORPORATION, Ali rights resort
<br />lNS62fi,a�,tvaam TNm df`fte n na+roo and L�nr-. ova reels mrad rx+oxLn n4 artY1Rn
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