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DEC-9.7-2 8 01:38P FROM: <br />QGD, <br />PRODUCER (j <br />Lake In! <br />13891 Ne~ <br />Lic #074 <br />Tustin, <br />INSURED Ora <br />Art <br />2Z1 <br />San <br />T0: 17145652602 P.2~3 <br />°TN CERTIFICATE OF LIABILITY INSURANCE liii6izoo8l <br />4)838-1912 FAX (714)838-7568 THlS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />•ance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />ort Ave. , 5ui to 285 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />73 <br />92780 <br />e County Children's <br />enter Inc <br />N Broadway <br />Ana, Ca 92706 <br />INSURERS AFFORDING COVERAGE NAIC # <br />c INSURERa Philadelphia Insurance Co. <br />INSURER B' <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />THE POLICI 4F INSURANCE LISTED BELOW HAVG BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING <br />ANY REQUI KENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MA` ~ BE ISSUED OR <br />MAY PERTf THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. f ~REGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />oEr <br />X <br />A <br />GEP <br />ALIT <br />A X <br />X <br />GAr <br />EXC <br />WORKER: <br />EMPLOYE <br />ANY PR01 <br />OFFiCERI <br />A <br />DESCRIP~ION 0 <br />ertitica- <br />buse & Mr <br />his Insul <br />nsured's <br />"10 Day nl <br />I <br />The <br />Emp <br />Att <br />888 <br />$U'1 <br />San <br />TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMr'S <br />aLLIABILITY PHPK37OS76 12/21/2008 12/21/2009 EP.CH000UARENCE $ 1,000,000 <br />~MMERCIAL GENEAAL LIABILITY DAMAGE TO RENTED% $ ZOO, OO <br />,CLAIMS MADE ~ OCCUR MED EXP (Arty one person) S 5 000 <br /> PERSONAL 8 AOV INJURY S 1, OOQ OOO <br /> GENGRALAGGREGATE S 2~000,OQO <br />,GGGEGATE LIMIT APPLIES PER: PRODUCTS - COMplOP AGG S x , 000 000 <br />~L1CY jfiCT LOC <br />OBILE LIABILITY PHPK370576 12/x1/2008 1Z/21/zOO9 COMBINED SINGLE LIMIT <br />Y AUTO (Ee exident) $ 1, OOO OOO <br />L 0 WNED AUTOS BODILY INJURY $ <br />HEDULEO AUT09 <br />(Perperson) <br />tE0AUT03 BODILY INJURY $ <br />IN-OWNED AUTOS (Per eccfdern) <br /> RM <br /> ~+ Tp FA PROPERTY DAMAGE <br /> <br />'D AS <br />(per eccfdent) $ <br /> <br />ELIABIUtY AUTO ONLY-EAACCIDENT $ <br />!Y AUTO > <br />R pTHER THAN EA ACC $ <br /> - <br />/~' ~'~ 'E <br />ST O AUTO ONLY; <br /> ~ <br />, e AGO $ <br />ilUMBRBLLA LIABILITY I pant ( EACH OCCURRENCE $ <br />;CUR ~ CLAIMS MADE BS (/L- AGGREGATE 5 <br /> <br /> <br />DUCTIBLE S <br />TENTION $ $ <br />IMPENSATION AND C STATU- OTH <br />LIABILITY <br /> <br />TO R/PA RTNERIEXECUTIVE E.L EACH ACCIDENT $ <br />46ER EXCLUDED9 E.L. DISEASE • EA EMPLOYEI: $ <br />under <br />VISIONS below <br />E.L. DISEASE • POLICY LIMIT <br />$ <br />oral Liability PHPK370576 12/21/x008 12/21/2009 Incident Limit: $1,000,000. <br /> Aggregate Limii: $2,000,000. <br />'ERATIONS f LOCATEOr(S 1 VEFf ICLES! EXCLUSIONS ADpED BY ENDORSEMENT! SPECIAL ROVIS <br />holder is AdditTOnal Insured as ner farm CG205 11/8 IONS <br />5) <br />astation is included with General Liability, $25,000 Eash Incident and X50,000 Aggregate <br />Tce Shall be Primary and Non-Contributory but Only in the Event of the Named <br />ale Negligence <br />ice for non-payment of premium <br />8HOULD ANY OF THE AEOVL' DCSGRIBED POUCIE9 BE GANCELL ED BEFORE TH6 <br />ity of Santa Ana, Its Officers, Agents, ExpIRATTONDATETHEREOF,THEISSUINGINSURERWILLENDFJ.VORTOMAIL <br />yees & Vol unteers 3O~ PAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER!' AMED TO THE LEFT, <br />Frances Cadenas/Donna Schultz <br />Santa Ana Blvd . BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGA"ION OR LIABILITY <br />ZOO OF ANY KING UPON THE INSURER, ITS AGENTS OR REPRESENTP INFS. <br />Ana, CA 92702 AUTHORIZED REPRE9ENTA7`IVB <br />AcORD as ( o~rosj <br />{ P+ <br />OACORD (:ORPORATION 9988 <br />