ORANGE COUNTY CHILDREN'S THERAPEUTIC ARTS CENTER 1

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"� hr CERTIFICATE OF LIABILITY INSURANCE F DATE 1/161/20113 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lake Insurance Agency 653 South B Street, Suite 200 Lic #0747473 Tustin CA 92780 coAMNTE: ACr Athena Stark N FNAXC No: (n4)9J9-7569 PHONEsu. (714) 838-1912lAdc Ef.1ARR .athena@lake ins. com INSURERS AFFORDING COVERAGE NAICN INSURERARhi1adel hia Indernts, Ins. Co. 18058 INSURED Orange County Children's Therapeutic Art Center, Inc. 2215 N. Broadway Santa Ana CA 92706 INSURER B : INSURER Ci I INSURER D: _ INSURER E: INSURER F: nnweo Anre nrGTlrl`ATe Kit 1MpICO.19-1Q Pkn G Pvnf TA nh RFVISIITN Ni IMRFR' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS - INSR LTR TYPE OF INSURANCE ADDLSUSR I POLICY NUMBER POLICY EFF !.l'YMO,YYYY POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMGE PRE�I E TO To occuD ce S 1,000,000 MED EXP (Any writ person) S 20,0000 A CLAIMSi.uDE 1XI OCCUR PliPK947781 12/21/2012 2/21/2013 PERSONAL L ADV INJURY S 1,000,000 _ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPiOP AGO S 2,000,000 I$ X POLICY PRO- LOGI AUTOMOBILE LIABILITY A COMBINED SINGLE LIMIT Ea accident) 1,000,000 BODILY INJURY (Par person; S ANYAUTO A ALL OWNED SCHEDULED UPK947781 2/21/2012 2/21/2013 500ILYINJURY(Peraccken) 7- AUTOS AUTOS X X - NON D PROPERTY DAMAGE PeracciCcnt S HIRED AUTOS AUTOS $ UMBRELLA LIAR OCCUR URRENCE S H TE S EXCESS LIAR CLAIhISfdADE DIED RETENTIONS S WORKERS COMPENSATION TATIIT OTH- AND EMPLOYERS' LIABILITY AN'Y PROPRIETORIPARTNERIEXECUTIVE WACCIDE�S SOFFICERIME).1SE0. EXDLL'DED7.(Mandatory NIAACCIDENT in NH) SE -EA EMPLOYE SII SE. POLICY LPIP SA yes, describe underDESCRIPTION OF OPERATIONS belan Professional Liability HPK947781 2/21/2012 2/21/2013L Each lnddem $2MIL Agg.Abuse & Molestation included Each Incident $50k Agg. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORO 101, Additional Remarks Schedule, If more space Is required) Re: Insured's operations under contract with Additional Insured; The City of Santa Ana, Its Officers, Agents,Employees & Volunteers Representatives - WIA as Additional Insured per CG 20 26 07 04, Primary and Non-Contrihutory applies per PI-MANU-1(01/00) but Only in the Event of the Named Insured's Sole Negligence, as required by written contract with Named Insured. OR1+ � L_15:t 11 E (714)565-2602 jcastro-cardenas@santa-ana The City of Santa Ana Its Of£icers,Employees,Agents,Volunteers and Representatives - WIA Attn: Julie Castro -Cardenas 1000 E Santa Ana Blvd #200 Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE THE EXPIRATION DATE 1 ACCORDANCE WITH TH OL AUTHORIZED REPRESENTATIVE Lake-C/L/ATHENA ;ANCELLED BEFORE BE DELIVERED IN iT�lliLiIrT6U1' INS02F,Jntrfbr dr Th. ACnlen nemo end Inns aru rnnlefe.o,l me rlre of Arnssn EXHIBIT i CORPORATION. All rights reserved.