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OP ID: RY <br />R CERTIFICATE OF LIABILITY INSURANCE <br />A44. <br />DATE D7YYYY, <br />05/15 <br />06115114 <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(ios) 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 ondorsement s . <br />PRODUCER <br />Narverinsurance 826. 943 -2200 <br />641 W. Las Tunas Drive 26. 299.1010 <br />PO Box 1509 N_2014 -07� <br />San Gabriel, G. ,CAton <br />Wesley G. Hampton <br />CONTACT <br />NAME_ - „_Ryan Wood <br />PNO "e .626. 943.2213 agNal, 626.299.1010 <br />p40RE5S: PWOOd OGindNer.COm <br />PRODUCER KIDWO -1 <br />cu O � <br />INSURER (S) AFFORDING COVERAGE <br />NAICM <br />_ <br />INSURED KidWorks Community Development <br />Corporation <br />1902 West Chestnut Avenue <br />Santa Ana, CA 92703 -4304 <br />INSURER A: Philadelphia (Internally Ina. <br />18058 <br />Everest National Insurance <br />INSURERa___,_ <br />16126 <br />_ <br />uRERc <br />_LN <br />NSURER D <br />EACH OCCURRENCE <br />INSURERE: <br />PREMISES Ea ecsur..ace <br />INSURER <br />A <br />COVERAGES CERTIFICATE NUMRER- REVISION NUMRFR: <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 />ICTR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />(MMIDDJYYYyI <br />PMIDDIYYYP <br />LIMITS <br />OENERALLIABILITY <br />EACH OCCURRENCE <br />$ 11000,600 <br />PREMISES Ea ecsur..ace <br />$ 10,600 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />X <br />PHPK1120959 <br />01107714 <br />01/67/15 <br />MED EXP(Any one person) <br />$ 5;000 <br />CLAIMS -MADE X OCCUR <br />PERSONAL A ADV INJURY <br />$ 1,000,000 <br />GENERALAGGREGATE <br />$ 3,000,000 <br />GEHL AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS- COMP/OP AGO <br />$ 3x000,000 <br />X POLICY � PIiO. LOD <br />..._. _ <br />$ <br />AUTOMOBILE <br />" —, <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ 11000,000 <br />BODILY INJURY (Par person) <br />$ <br />ALL OWNED AUTOS <br />!. <br />�9041LY INJURY (Peracpitlenl) <br />$ <br />A <br />X <br />SCHEDULED AUTOS <br />HIREDAUTOS <br />li <br />' <br />PHPK1120959 <br />i <br />01107/14 <br />01107/15 <br />pRORERTV DAMAGE <br />(Per accitlanO <br />$ <br />A <br />X <br />NON -OWNED AUTOS <br />PHPKI120959 <br />01107114 <br />01/07/15 <br />$ <br />$ <br />X <br />UMBRELLA LIAR XrOCCUR <br />EACH OCCURRENCE <br />1,000,000 <br />AGGREGATE <br />$ 1,000,000 <br />A <br />- -- <br />EXCESS UAB CLAIMS -MADE <br />°_.._..._._____ ---- - - - <br />PHUS446716 <br />! 01107114 <br />01/07/15 <br />$_ <br />DEDUCTIBLE <br />! <br />$^ <br />X <br />RETENTION $ 10,000 <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNEWEXEOVTIVE YIN <br />OFFICEWMEMBER EXCLUDED? <br />(Mandatory In NH) <br />NIA <br />CA1000flS3161 <br />v <br />02/01/14 <br />02101/15 <br />X WC STAM TS H. <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />I_EL DISEASE - EA EMPLOYEE <br />$ 1,000,900 <br />If py des.1he under <br />DESCRIPTI N OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />A <br />Professional <br />PHPK1120959 <br />01107114 <br />01107/75 <br />Each 1,000,000 <br />Liability <br />000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Ia recoiled) <br />RE: EidWOrk3 20th Birthday Celebration - May 29,2014 from 5:30 -9:30 pm <br />City of Santa Ana is named as Additional Insured as respects attached <br />P endorsement. "'^"• <br />In the event of non�Aayment_o£ premium, ten (10) days notice of cancellat' n _ .(OSP_�"r1.DdOV , <br />will b� —givdn -_— _ ..- <br />UCKIIrRoAl n MULUCK - GANGCLLAIIUN — - -" <br />SANTAAN <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City f Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Y ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 AUTHORIZED REPRESENTAT VE <br />©1988.2009 ACORD CORPORATION, All rights reserved. <br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD <br />