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.4.+cOJRD CERTIFICATE OF LIABILITY INSURANCE
<br />`-�"�
<br />DATE(fAIA1DDlYYYY)
<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 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(ies) 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 endorsement(s).
<br />PRODUCER
<br />Lake Insurance Agency
<br />653 South 8 Street, Suite 200
<br />CNA04NITAOT Athena Stark
<br />P oNE (714)838 -1912 FAX (714)838 -7568
<br />E -MAIL athena @lakei »a,aom
<br />Lid #0747473
<br />Tustin CA 92780
<br />INSURERS AFFORDING COVERAGE
<br />NAICaI
<br />INSURER A:Phi lade l hia Indemity Ins. Co.
<br />18058
<br />INSURED
<br />INSURER B:
<br />Orange County Children's Therapeutic
<br />INSURERC:
<br />$ 1,000,000
<br />Art Center, Inc.
<br />INSURER D:
<br />2215 N, Broadway
<br />INSURERE:
<br />2/21/2012
<br />Santa Ana CA 92706
<br />INSU e
<br />$ 5,000,000
<br />GUVtKALitS -A Pktr !G PrnA _ T,i ah DOWMIAM MI IaADCD.
<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 />INSR
<br />TYPE OF INSURANCE
<br />L
<br />POLICY NUMBER
<br />POLICY I1YYYY
<br />DOYEXP
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAINiS4AADE � OCCUR
<br />HPK997781
<br />2/21/2012
<br />2/21/2013
<br />PRAMAI E a N ,
<br />$ 5,000,000
<br />MEO EXP (An one person
<br />5 20,0000
<br />PERSONAL GADVINJURY
<br />$ 1,000,000
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />GENT. AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMNOP AGG
<br />$ 2,000,000
<br />X P01.IGY PRO LOC
<br />5
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED tSINGLE LIMIT
<br />11000,000
<br />80DILY INJURY (Parperson)
<br />5
<br />A
<br />X
<br />ANY AUTO
<br />ALL OWNED AUTOSULEO
<br />HIRED AUTOS X NON- O'NNED
<br />AUTOS
<br />HPK947781
<br />12/21/2012
<br />2/21/2013
<br />BODILY INJURY (Peracc ?dent)
<br />S
<br />PROPERTY DAMAGE
<br />P accident
<br />$
<br />$
<br />UMBRELLA LIAB
<br />HCLAIMS4AADE
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />EXCESS LAB
<br />AGGREGATE
<br />$
<br />OED I I RETENTIONS
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR /PARTNEREXECAJnVE
<br />OFFICERMFMBER EXCLUDED7,
<br />N/A
<br />WCSTATU- OTH-
<br />T
<br />E.L EACH ACCOENT
<br />S
<br />E. L. DISEASE - EA EMPLOYE
<br />S
<br />(Mavdatory In NH)
<br />If yes, descn1a under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />5
<br />A
<br />Professional Liability
<br />FHPK947782
<br />12/21/2012
<br />2/21/2013
<br />Lim "it:S1MIL Each ImIdent 42MIL Agg.
<br />Abuse & Molestation
<br />Included
<br />Unit $25k Each lncldant $50k Agg.
<br />DESCRIPTION OF OPERATIONS / LOCArONS /VEHICLES (Attach ACORD 101, Additlonal Remarks schedule, If more space Is required)
<br />Re: Insured's operations under contract with Additional Insured; The City of Santa Ana, Its Officers,
<br />Agents,Employees & Volunteers Representatives - WIA as Additional Insured per CG 20 26 07 04, Primary
<br />and Non - Contributory applies per PI- MANU- l(C1 /00) but Only in the Event of thw Named Insured's Sole
<br />Negligence, as required by written contract with Named Insured. 'V�
<br />I 1
<br />vcn i rnvn nv�ucrc GAINUtLLA I IUN 15,V S
<br />(714)565 -2602 Castro- Cardenas @ santa -ana
<br />7 SHOULD ANY OF THE ABOVE bEB�( �Ci,E tz°'�iA�CELLEb BEFORE
<br />THE EXPIRATION DAT_E�HEREOF,naE L BE DELIVERED IN
<br />The City of Santa Aria ACCORDANCE WITH THEPOLICYP(�Q�V�$iFifYS,
<br />Its Officers ,Employees,Agents,Volunteers AUTHOR(ZEOREPRESENTATIVE �"
<br />and Representatives - WIA
<br />Attn: Julie Castro - Cardenas
<br />1000 E Santa Ana Blvd #200 .-
<br />Santa Ana, CA 92701 Bob Lake -C /L /ATHENA
<br />AL:UKU AD tLUIU /Ub) w J ©1988 -2010 ACORD CORPORATION. All rights reserved.
<br />fN�in28r�ninnstn Th. Af'ngil nzme a �,.o'n r l-18 m ,Lr. of A(:0Rn
<br />
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