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ACAO P, CERTIFICATE OF LIABILITY INSURANCE 04ATE MM DONYYY /05/2013) PRODUCER 310.393.9477 FAX 310.393.7186 White & Company Insurance Inc. P O Box 70 Santa Monica, CA 90406 -0070 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Women's Transitional Laving Center PO Box 6103 Orange, CA 92863 � �� ✓J lry tf7- ( / / /f• INSURERA: Philadelphia Ins Co 30" DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, INSURERS: Frank Hernandez NSURERC: PHPKI002647 INSURER D: EACHOCCURRENCE INSURER E: DAMAGET -RENTED COVERAGI THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTH E POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR JaH. kDWL h= TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION MMIDDIYYI 04/04/2014 LIMITS 30" DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, A Frank Hernandez GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE ® OCCUR PHPKI002647 04/04/2013 EACHOCCURRENCE $ 1,000,00 DAMAGET -RENTED $ 1,00-0,00-0- $ 20,000 MW EXP (Any one parecn) PERSONAL B ADV INJURY $ 1, 000,00 GENERAL AGGREGATE $ 2,000,000 GEHL AGGHEGATE LIMIT APPLIES PER X POLICY PRO- JECT OC PRODUCTS - COMP /OP AGO $ 1,000,00 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED NON -O WNED AUTOS PHPKI002647 e 04/04/2013 Lisp, 04/04/2014 y� yp TO �^ { }vi 1 ) p(�GK tOTT1ey COMBINED SINGLE LIMIT (Ea accident) $ 1, 000 OO X (Per INJURY peeon) $ X BODILY INJURY -Per accidenQ $ X PROPERTY DAMAGE (Per acoldenl) $ GARAGE LIABILITY ANY AUTO ASST ^ jl AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY. AGG $ $ A EXCESS/UMBRELLALIABILITY OCCUR ❑CLAIMS MADE DEDUCTIBLE X RETENTION IS 10,00 PHUB416811 04/04/2013 04/04/2014 EACH OCCURRENCE IS 5,000,00 AGGREGATE $ 5,000,00 $ IS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANV PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WC STATD- OTH- E.L. EACH ACCIDENT -^ $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS ity of Santa Ana, its officers, agents, employees, and volunteers are additional insureds as per form G 20 26 07 04 and Primary Insurance as per form CG 00 01 1207, both attached to the general liability olicy and accompanying this certificate. *Except for 10 days written notice of cancellation for non - payment of premium, CFRTIFir: ®T"F I-IOI. nFR rAMPCP I AT,nu ACORD 25 (2001/08) 11 714.647.6549 OACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City f Santa Ana - CDBG M -25 EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ESGy 30" DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn: Frank Hernandez BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY P.O. Box 1988 M -2 S OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE ,Sally Austin SAl ACORD 25 (2001/08) 11 714.647.6549 OACORD CORPORATION 1988