TALLER SAN JOSE HOPE BUILDERS (3)

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oRo® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 0210412019 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 Marsh USA Inc. 1301 51h Avenue, Suite 1900 SeatOe, WA 98101 Aft Jennifer Caudebec-206-214-3156 15105 INSURED Providence St. Joseph Health Sisters of St. Joseph of Orange 1801 Lind Ave SW #9016 Renton, WA 98057-9016 COVERAGES CERTIFICATE NUMBER: SEA-003556643-04 REVISION NUMBER: 3 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 ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY) POLICY EXP AMMIDDIYYYYJ LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMSWIDEOCCUR PREMISES Ea occurrence $ MEO EXP (Any one person) $ PERSONAL B ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO- ECT LOC GENERAL AGGREGATE $ PRODUCTS - COMPIOP AGG $ $ OTHER. - AUTOMOBILELIASILITY COMBINED SINGLE LIMIT Ea accident $ DODILY INJURY Par porson) ^. ANY AU I J OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per acciden0 $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEO I I RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNER/EXECUTIVE YIN OFFICERIMEMBEREXCLUDED? (Mandatory in NH) NIA SP4059664 SIR: $2,000,000 0110112021 X PER OTH- STATUTE ER E. L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) SSJO dba Taller San Jose, Block Grant, 810 N. Poinsetla, Santa Ana, CA 92701 / � Re. SSJO dba Taller San Jose, Block Grant, 810 N. Poinselta, Santa Ana, CA 92701 -Z67- C ✓ S�l /L CERTIFICATE HOLDER CANCELLATION City of Santa Ana, its officers, agents SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Adn: David Flores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza; No. M25- P.O. Box 1980 ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Jean Aguirre ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD