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6co, �� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE l.A 2013 I
<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 INSURERS), 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 policles 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 />CONTACT Athena Stark
<br />HAVE:
<br />PHONt lol. (714)838-1912NC Nn: a1n>aTa-rsee
<br />Lake Insurance Agency
<br />E'nlORE All'5' athena@lakeins. com
<br />AD
<br />653 South B Street, Suite 200
<br />Lic N0747473
<br />INSURERS AFFOROINGCOVE RAGE
<br />NAIC9
<br />INsuRERn Philadelphia Indemnity Ins, Co.
<br />_
<br />18058__
<br />Tustin CA 92780
<br />INSURED
<br />INSURER a:
<br />INSURER
<br />Orange County Children's Therapeutic
<br />INSURER D:
<br />Art Center, Inc.
<br />INSURER E:
<br />2215 N. Broadway
<br />.Santa Ana CA 92706
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER 12-13 Pkg s Prof. Liab. REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 1,
<br />INDICATED. NOTVIITHSTANDING ANY REQUIREMENT, ri OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERIIFICATE 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 W N MAY HAVE BEEN REDUCED BY PND CLAIMS.
<br />ILTRi
<br />LTR TYPE OF INSURANCE
<br />ADDC
<br />t
<br />SUBR
<br />p
<br />-- "-
<br />POLICY NUMBER
<br />POLICY EfF
<br />!.1!.1100Mf1Y
<br />• POLICY -EX
<br />Alhi;00 YYYY
<br />LIMITS
<br />GE N ERAL LIABILITY
<br />EACH OCCURRENCE
<br />S 11000,000
<br />I A
<br />X UO: hIERCmL CENERALLIABILITY
<br />t,IAA!Sb1ADE X OCCUR
<br />` [__
<br />�
<br />HPX947781
<br />I
<br />i2/21/_01212/21/2013
<br />'
<br />H$A e1 lz RENTED
<br />pR y_m]
<br />_ 1,20, 000
<br />IEDEXPtAEe ro
<br />oFxP (Any crapes )
<br />s 20, 0000
<br />S
<br />PERSONAL& ADVINJURY
<br />5 1,000,000
<br />GENERAL AGGREGATE
<br />S 2,000,000
<br />P_RODUC rS- CU%IPiOP AGG
<br />S 2,000,000
<br />` GPI L AGGREG_ATF I CIT APPLIES PER.
<br />-
<br />S
<br />X PCUCY� PRO - _CC
<br />AUTONIOBILE UABII.ITr
<br />COAQ,NED SINGLE Umir
<br />: 1 --deL
<br />S 1 0_00 0_0O
<br />BODY Y INJURY (Pep on)
<br />S
<br />ANY AUTO
<br />_ ALL OVINEO SCHEDULED
<br />AU -OS 1 IAUTOS
<br />X- HIRED AJTOS X NON OM11ro
<br />li
<br />HPK947781
<br />r, ,
<br />12/21/201212/21/2013
<br />.YS TO
<br />BODILY INJURY (Ie EenO
<br />5
<br />PROPERTY
<br />DA!.V1 EAUT
<br />_
<br />-_—_..._�
<br />5
<br />_
<br />UMBRELLA LIAB
<br />pCl:Jfi
<br />F/V
<br />EACHOCCURRE.NCEE.
<br />5
<br />-_
<br />AGGREGATE
<br />5
<br />ESS LIARETEN
<br />OLAPAS�IAUE
<br />/,_,-
<br />C It
<br />s
<br />VCRIERS COr1PENSANON
<br />AND EMPLOYERS' LIABILITY YIN•
<br />ANY PRCPR.ErORt EKCLJDR % CUi.VE
<br />"'KEPI E, EXCJDC
<br />N f A'
<br />-
<br />Sn)stdlTt'ti
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<br />y
<br />tCSTARJ
<br />IdLL.
<br />----
<br />EL EACH PeCI0FY1
<br />s
<br />- - - --
<br />EL DISEASe -EAF 1PlO'fE
<br />-
<br />$
<br />(hl datory NI17
<br />NIH
<br />DESCRIPTION OF OPERATIONS xlvv
<br />I
<br />///YYY
<br />� �
<br />- I
<br />FLUISEASE-POI I6YLR.Er
<br />S
<br />_
<br />LaW S11et Eaa,l„udenl $21MIL Agq.
<br />A '
<br />Professional Liability
<br />HPH947781
<br />12/21/2012'
<br />2/21/2013
<br />Abuse 6 Molestation
<br />I
<br />Included
<br />Lime$25, Each ln,dent $50k Agg.
<br />DESCRIPTION CF OPERATIONS f LOCATIONS 'VEHICLES (Altach ACORD 101, Additional RmIarka Schedule, IT more space A r.,Ll,.d(
<br />Re: Insured's operations under contract with Additional Insured; The City of Santa Ana, Its Officers,
<br />Agents,Employess L Volunteers Representatives - WIA as Additional Insured per CIS 20 26 07 04, Primary
<br />and Non -Contributory applies per PI-DINNU-1(01/00) but Only in the Event of the Named Insured's SOla
<br />Negligence, as required by written contract with Named Insured.
<br />CERTIFICATE HOLDER CANCELLATION
<br />I(714)565-2602 jcastro-cardenas@santa-ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />The City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Its Officers,Employees,Ager.ts,Volunteers
<br />AUP40RIZED REPRESENTATIVE
<br />and Representatives - WIA
<br />Attn: Julie Castro -Cardenas
<br />Sant E Santa Ana Blvd 42O0
<br />Santa Ana, CA 92701
<br />- �'��= '—
<br />Bob Lake-C/L/ATRENA -'
<br />ACORD 25 (2010105) ©1988"2010 ACORO CORPORATION. All rights reserved.
<br />NSn25,amwrw , TI— Ar]n4rl na .—I Innr. are renle rnwd -I. n! A!`ngn
<br />
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