YOUNG MEN'S CHRISTIAN ASSCIATION OF ORANGE COUNTY

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ACOR" CERTIFICATE OF LIABILITY INSURANCE �/ DATE (Mmloo m0 v10/2019 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 have ADDITIONAL INSURED provisions or 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 rl Bolton & ComCany 3475 E. Foothill Blvd., Suite 100 Pasadena, CA 91107 CONTACT NAME: PHONE s2s 7ss-7oo0 a Na: szs sa3-z117 E� AIL ADDRESS: INSURERS AFFORDING COVERAGE NAICp INSURER A: The Hanover American Insurance Company 36064 www.boltonco.com 0008309 INSURED YMCA of Orange County INSURER B: Quality Comp, Inc. 38865 13821 Newport Avenue Suite 200 INSURER C: INSURER:: Tustin CA 92780 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 4R4117f)09 REVISION NUMBER: 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 TR OF INSURANCE ADDLTYPE JIM MD SUER POLICYNUMSER MMIDDPOLICYEFF POLICY LIMITS A COMMERCIALGENERAL LIABILITY ✓ ZZ3D79134000 1/1/2019 1/1/2020 EACH OCCURRENCE $1000000 / CLAIMS -MADE OCCUR ✓ DAMAGE TO RENTED PREMISES Ea occurrence $1 000 000 ✓ MED EXP (Any one person) $20 000 Includes Sexual Abuse Coverage PERSONAL &ADV INJURY $1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JE0 LOG PRODUCTS-COMPIOP AGO $2000,000 $ OTHER: A AUTOMOBILE LIABILITY AW3D79131300 1/1/2019 1/1/2020 EaeBccdent$INGLE LIMIT $1,000,000 BODILY INJURY(PerPrson) $ AUTO NANY OWNED SCHDULED AUTOS ONLY AUTOHIRED BODILY INJURY(Par accident) $ NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTVDAMAGE Per ecuden[ $ A r/ UMBRELLALIAB 1/ OCCUR UH3D79134100 1/1/2019 1/1/2020V EACH OCCURRENCE $15000000 AGGREGATE $15 000 000 EXCESS LIAR CLAIM$ -MADE DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNEWEXECUTIVE YIN OFFICERIMEMBEREXCLUDED1 F_N] NIA 0150620317 1/1/2019 1/1/2020 L,r/ I PE STATUTE ERA E.L. EACH ACCIDENT $1000000 E.L. DISEASE -EA EMPLOYEE $ 1 000 ,000 (Mandatary in NH) USA describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMB I $1000000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GL Additional Insured and Primary & Non -Contributory Wording apply per 42129150615 attached, only if required by written contractlagreement. GI -Cancellation Clause applies per IL00171198 attached. Re: Operations of the Named Insured. Additional Insured(s): City of Santa Ana. CERTIFICATE HOLDER CANCELLATION Cl of Santa Ana City SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE to Center Plaza 20te THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana, Plana ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Candice Solar, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 96987002 1 19-20 GL ADM EXCESS 19-20 WC I Nancy Cadwallader 1 1/10/2019 IDA3:96 AM (PST) I Page 1 of 6