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JU1 , e, CciF - C <br />iA <br />A� D" CERTIFICATE OF LIABILITY INSURANCE <br />D/ 16 / 100/1 YYY) <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 B Street, Suite 200 <br />Lic #0747473 <br />Tustin CA 92780 <br />CNAME•ONTACT Athena Stark <br />(714)838-1912 FAx (714)BJB-TSfiE <br />PHONN EXITE No: <br />A01AgLESS: athena0 lakeins. com <br />INSURERS AFFORDING COVERAGE <br />NAICA <br />INSURER A:Philadel hia Incleruaity Ins. Co. <br />18058 <br />INSURED <br />Orange County Children's Therapeutic <br />Art Center, Inc. <br />2215 N. Broadway <br />Santa Ana CA 92706 <br />INSURER B <br />INSURER C: <br />INSURER o: _ <br />INSURER E: <br />1 INSURER F: <br />nnveo Acvc C ERTICIIATCNIIM1ARCR•19-1R Pkn A Pro£.Liab. KEVISIUIN NUMtlbK: <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 />LT <br />TYPE OFADDLSUBR <br />19 <br />POLICY NUMBER <br />POLICYEFF <br />Mh1IDDIYYYY <br />POLICYEXP <br />MMIODIYYYY <br />LIMITS <br />GENERAL LIABILITY <br />FACH OCCURRENCE <br />S 1,000,000 <br />X CO61h1ERCIALGENERALLIASILITY <br />Ak AGET N D <br />PREMISE Eaoaarr rce <br />$ 1,000, 000 <br />MED EXP(An ana parson) <br />$ 20,0000 <br />A <br />CLA.IS+VADE fxJ OCCUR <br />PHPK947781 <br />2/21/2012 <br />2/21/2013 <br />PERSONAL B ADV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER. <br />PRODUCFS-COMP;CPAGG <br />S 2,000,000 <br />$ <br />X POLICY PRO- LOG <br />110,TAUTOMOBILE <br />LIABILITY <br />I Ea ecc Ceop$INGLE LIh1n <br />S 1,000,00 0 <br />BODILVINJURY(Per person) <br />5 <br />AJx <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTOS X AUTOS <br />HPK947781 <br />12/21/2012 <br />to <br />2/21/2013 <br />�p <br />�RM <br />BODILY INJURY IPet a2idenl) <br />$ <br />F., ortl 'D Ah1AGE <br />S <br />UMBRELLA UAB <br />EXCESS LIAR <br />OCCUR <br />GLAR.i$d1A0E <br />T( <br />A rte <br />c <br />STORC <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DEO RETENTIONS <br />5 <br />WORKERS COMPENSATION <br />AND EMPLOYERSLIABILITY YIN <br />ANY PROPRIETOMPARTNERIEXECUTIVE❑ <br />OFFICERIMPABER EXCLUDED, <br />(Mandatory In NMI <br />NIA <br />A55 istant <br />City A O <br />'J/l <br />WCSTATU- OTH- <br />E.L. EACHAGCIOENF <br />S <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />E.LUISEASE-POLICY LIMIT <br />I S <br />If yes, describe under <br />DESCRIPTION OF OPERATIONShebu <br />A <br />Professional Liability <br />HPK947781 <br />2/21/2012 <br />2/21/2013 <br />LimiI:SIMILEachlncident $2MIL Agg. <br />Abuse & Molestation <br />ncluded <br />Lint S25k Each incident $50k Agg. <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD tot, Additional Remafits 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 S Volunteers Representatives - WIA as Additional Insured per CG 20 26 07 04, Primary <br />and Non -Contributory applies per PI-MANU-1(01/00) but Only in the Event of the Named Insured's Sole <br />Negligence, as required by written contract with Named Insured. <br />(714)565-2602 jcastro-cardenas@santa-ana <br />The City of Santa Ana <br />Its Officers,Employees,Agents,Volunteers <br />and Representatives - WIA <br />Attn: Julie Castro -Cardenas <br />1000 E Santa Ana Blvd #200 <br />Santa Ana. CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REP RES ENTATIVE <br />Bob Lake-C/L/ATHENA <br />I NR025 mm�ns� m <br />n 4M8R_9LNn ACORO CORPORATION. All rlahts reserved. <br />Th. Arno name and Innn era ran le lorod m rlee n( An, noln <br />