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rAC <br />.,SRO. CERTIFICATE OF LIABILITY INSURANCE WI EOP PLDI SB <br />DAR02 /13 /( <br />PROvUCER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />POLICY NUMBER <br />POLN:Y EFFECTIVE <br />GATE ( "'OoNn <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />(SAOC) <br />Heffernan Ins. Brkrs <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />1855 W. <br />Katella Ave., #255 <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />EACH OCCURRENCE <br />$ 1,000,000 <br />Orange CA 92867 <br />Phone: <br />714- 997 -8100 Fax: 714- 997 -1994 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />A -2007- 105 -044 <br />INSURER A. PNilaG�lPNi� LMrllty I— G <br />CLAIMS MADE OCCUR <br />INSURER B: <br />Wiseplace, a CA Corporation <br />S 5,000 <br />Kathi Bowman <br />INSURER C: <br />INSURER D: <br />5 1,000,000 <br />1411 N. Broadway <br />Santa Ana CA 92706 <br />INSURER E: <br />- — <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />My REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIF CATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR� L <br />LTR SRD <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLN:Y EFFECTIVE <br />GATE ( "'OoNn <br />POLICY EXPIRATION <br />LIMIT* <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />A X <br />X COMMERCIALGENEHALLIABILITY <br />PHPK203603 <br />01/01/07 <br />01 /01 /08 <br />DAMAGE TO RENTED <br />PREMISES (F. acurtanoe) <br />S 100,000 <br />j <br />CLAIMS MADE OCCUR <br />MED EXP IA,y one PefLPAI <br />S 5,000 <br />PERSONAL& ADV INJURY <br />5 1,000,000 <br />uProf. Liability <br />GENERAL AGGREGATE <br />S 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMPIOP AGG <br />S 2,000,000 <br />1 <br />OLICr -OT LOC <br />X POLICY - <br />OCC / <br />$lmm / $2mm <br />A <br />AUTOMOBILE <br />X <br />LLABILITY <br />ANY AUTO <br />PHPK203603 <br />01/01/07 <br />01/01/08 <br />COMBINED SINGLE LIMIT <br />(E " fG—) <br />S 1,000,000 <br />BODILY IN.IURY <br />(Aw P IO ) <br />S <br />ALL OWNED JTD. <br />SCHEDULED AUTOS <br />BODILY INJURY <br />(P....i nD <br />S <br />X <br />HIRED AUTOS <br />NON -OWNEDAUTOS <br />X <br />(PIX..kWI PROPERTY DAMAGE <br />$ <br />P, <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT <br />f <br />OTHER THAN FA ACC <br />$ <br />ANY AUTO <br />S <br />AUTO ONLY: AGG <br />A <br />HO(CEBSNMBR "LJABILJtt <br />X OCCUR ❑ CLAIMS MADE <br />PHUB074946 <br />01/01/07 <br />01/01/08 <br />EACH OCCURRENCE <br />5 1,000,000 <br />AGGREGATE <br />5 1,000,000 <br />S <br />DEDUCTISLE <br />X RETENTION S 10,000 <br />S <br />W01"11 COMPENSATION AND <br />WC STATII- OTH- <br />EMPLOYERS•LIAMLffY <br />TCRY LILiiI� EI< <br />E.L. EACH ACCIDENT <br />S <br />PR <br />ANY PROIETORIPARTNEIWEXECUTIVE <br />E.L DISEASE -EA EMPLOYE�I <br />S <br />OFFICERIMEMRER EXCLUDED? <br />II yAa. aescrpe unto <br />E.I. DISEASE -POLICY UNIT I <br />— . - - - -_— - <br />$ <br />SPECIAL PROVISIONS mi— <br />OTHER <br />A Property <br />PHPK203603 <br />01/01/07 <br />01/01/08 <br />Contents $ 250,000 <br />Deduct. $ 500 <br />DESCRNTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />Re: (HUD) Community Development Block Grant Funding for Women's Shelter "' +: �`v�'iJ� <br />AS .lt� <br />Certificate Holder S the attached are found as additional insured w/ regards <br />the above as respects GL coverage, but only if required by written agreement <br />with the Named Insured prior to an occurene per the attached Cr. 2026 (11/85) - _- <br />Endorsement. *10 Days Notice of Cancellation for Non - Payment of Premium, dli -2 ty <br />CERTIFICATE HOLDER CANCELLATION <br />CITY OF SANTA ANA COMMUNITY <br />DEVELOPMENT AGENCY M -25 <br />ATTN: MICHAEL GARCIA <br />P.O. BOX 1988 <br />SANTA ANA CA 92702 -1988 <br />SANTAAN SHOULD ANY DF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE El(PIRATION <br />DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MML *30 DAYS WRITTEN <br />NOTICE TO THE CERTMICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE INSURER, ITS AGENTS OR <br />K- -UI%U Lu (CUUIlvo) ©ACORD CORPORATION 1988 <br />