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DATE <br />ACORD. CERTIFICATE OF LIABILITY INSURANCE page I of 2 07107/2004 <br />PRODUCED 877 - 945 -7378 <br />Willis North America, Inc. - Regional cart center <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />26 century Blvd. <br />FOR THE POLICY <br />RESPECT TO WHICH <br />TO ALL THE TERMS, <br />POLICYEXPIRATION <br />A NY <br />P. 0. Box 305191 <br />Nashville, TN 372305191 <br />INSURERS AFFORDING COVERAGE <br />INSURED Sisters of St. Joseph of Orange <br />NSURERA. American Unity Group Ltd C0929 -001 <br />A <br />480 South Batavia <br />INSURER B: <br />INSURER C: <br />Orange, CA 92868 <br />INSURER D' <br />NSURER E. <br />td Af:f1RI7 CEIRPOR ATION 7988 <br />COVERAGES <br />THE <br />ANY <br />MAY <br />POLICIES, <br />INSR <br />T <br />POLICIES OF INSURANCE LISTED <br />REQUIREM -ENT, TERM OR CONDITION <br />PERTAIN, THE INSURANCE AFFORDED <br />AGGREGATE LIMITS SHOWN <br />TYPEOFINSURANCE <br />BELOW HAVE BEEN ISSUED TO THE INSURED <br />OF ANY CONTRACT OR OTHER <br />BY THE POLICIES DESCRIBED HEREIN <br />MAY HAVE SEEN REDUCED BY PAID CLAIMS. <br />POUCYNUMBER <br />NAMED ABOVE <br />DOCUMENT WITH <br />IS SUBJECT <br />POLICYEFFECTIVE <br />FOR THE POLICY <br />RESPECT TO WHICH <br />TO ALL THE TERMS, <br />POLICYEXPIRATION <br />A NY <br />PERIOD INDICATED. NOTWITHSTANDING <br />THIS CERTIFICATE MAY BE ISSUED OR <br />EXCLUSIONS AND CONDITIONS OF SUCH <br />LIMITS <br />6/30/2005 <br />EACHDCCURRENCE <br />S 2,000,000 <br />A <br />GENERALLIABILITY <br />UNI- CGL -04 -01 -020 <br />6/30/2004 <br />FIRE DAMAGE (Any one lire) <br />$ <br />X I COMMERCIAL GENERAL LIABILITY <br />CLAIMSMADE OCCUR <br />1 <br />td Af:f1RI7 CEIRPOR ATION 7988 <br />ME EXP(L&ADV person) <br />$ <br />PERSONAL BADV INJURY <br />$ 2 000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS- COMP /OPAGG <br />S <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PR� LOD <br />AUTDMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />ANY AUTO <br />ALLOWNEDAUTOS <br />BODILY INJURY <br />(Per person) <br />$ <br />SCHEDULEDAUTDS <br />HIREDAUTDS <br />BODILY INJURY <br />(Per accitlent) <br />$ <br />NON-OWNED AUTOS <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />AUTO ONLY - EA ACCIDENT <br />$ <br />GARAGE <br />LIABILITY <br />ANY AUTO <br />0 HERTHAN EA ACC <br />AUTO ONLY: AGG <br />$ <br />S <br />EACH OCCURRENCE <br />$ <br />EXCESS LIABILITY <br />OCCUR CLAIMSMADE <br />- - <br />l`a'�� <br />AS <br />AGGREGATE <br />$ <br />$ <br />_r i©VED <br />$ <br />DEDUCTIBLE <br />RETENTION $ <br />WORKERSCOMPENSATION AND <br />EMPLOYERS'LIABILITY <br />/d <br />C <br />f' K <br />C11�AYtOY h'° <br />WC STATU. I JOTH. <br />T A <br />$ <br />E. L. EACH ACCIDENT <br />$ <br />E.L.DISEASE -EA EMPLOYEE <br />$ <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />OTHER <br />DESCRIPTION OF OPERATIONS /LOCATIONS EHICLEStFXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />The Certificate Holder is named as Additional Insrued by endorsement to the policy subject to the <br />terms set forth in the endorsement. <br />Re: SSJO dba Taller San Jose, Block Grant - 810 N. Poinsetta, Santa Ana, CA 92701 <br />CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LEI mn: <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL X XK MAIL 30 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LErtlCEtilF1`]GJ�LiKXB}C11YLL <br />�Q1( AIOf��biJ l{ XIX�X' M' �` iSJQ1Y. ��Lf�O }ii�Q(Fi�JJfaIC5105']Q�SL(yf}�. <br />Santa Ana Work Center <br />Pl�ISHSa91Y %9€XX <br />1000 E. Santa Ana Blvd. <br />Suite 2000 <br />AU ORIZED ESENTAMVE <br />Santa Ana, CA 92701 <br />td Af:f1RI7 CEIRPOR ATION 7988 <br />ACORD 25- S(7197) C011:ltubJea rpL:26u>si <br />