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A� a® CERTIFICATE OF LIABILITY INSURANCE <br />DAT3l9/201gvvv) <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 />BEL06Y. 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 pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER Bolton & Company ® <br />3475 E. Foothill Blvd., Suite 100 <br />Pasadena, CA 91107 <br />NAME: CONTACT <br />PHONE ,t: 626799-7000 AIc NO: 626 583-2117 <br />EMAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAICIs <br />INSURER A: Philadelphia Indemnity <br />18058 <br />www.boltonco.com 0008309 <br />INSURED <br />YMCA of Orangge County <br />13821 Newport Avenue Suite200 <br />INSURER B: Quality Comp, Inc. <br />38865 <br />INSURERC: <br />INSURER D: <br />Tustin CA 92780 <br />INSURER E : <br />INSURER F : <br />COVFRAGFS CERTIFICATE NIIMRFR• nrnaanvn RFVISIOM MIIMRFR. <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 />LTR <br />TYPE OF INSURANCE <br />ADDLSUBR <br />myi?POLICY <br />NUMBER <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY EXP <br />MMIDDIYYYY <br />LIMITS <br />A <br />COMMERCIAL GENERAL LIABILITY <br />✓ <br />PHPK1784890 <br />3/1/2018 <br />1/l/2019 <br />EACH OCCURRENCE <br />$1000000 <br />CLAIMS -MADE OCCUR <br />✓ <br />DAMAGE I RENTED <br />PREMISES(Ed occurrence <br />$ 1 000 000 <br />✓ <br />MED EXP (Any one person) <br />$20 000 <br />Includes Sexual Abuse Coverage <br />PERSONAL &ADV INJURY <br />$1000,000 ' <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$2,000,000 <br />POLICY PRO ❑ LOC <br />ECT <br />PRODUCTS - COMPIOP AGO <br />$Z,000,OOO <br />$ <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />PHPK1784890 <br />3/1/2018 <br />1/1/2019 <br />COMBINED SINGLE LIMIT cident) <br />$1,000000 <br />- <br />BODILY INJURY (Per person) <br />$ <br />✓ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY nAUTOS ONLY <br />PROPEFTTYDAMAGE <br />(Per accident <br />$ <br />A <br />V1 <br />UMBRELLA LIAB <br />UMBRELLA LIAB <br />/L <br />HyEXCESS <br />occuR <br />PHUB619703 <br />3/1/2018 <br />1/1/2019 <br />EACH OCCURRENCE <br />$15,000000 / <br />AGGREGATE <br />$15, 000 000 <br />LIAB <br />CLAIMS -MADE <br />DED RETENTION$ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />OFFlCERPMEMBEREXCLUDEOXECUTIVE <br />NIA <br />0150820317 <br />1/1/2018 <br />1/l/2019 <br />�/ STATUTE �RH <br />E.L. EACH ACCIDENT <br />$1000,000 <br />E.L. DISEASE -EA EMPLOYEE <br />$1 OOO OOO <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTIONOFOPERATIONSbelow <br />E.L. DISEASE -POLICY LIMIT <br />'— <br />$1000000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />GL Additional Insured applies per CG20260413 attached. GL Primary & Non -Contributory Wording applies per PIG L0050712 attached. , <br />GL Cancellation Clause applies per PICANXAICH020511 attached. <br />Branch: AO; Activity: Santa Ana Financial Assistance Program; Group: Loma Vista Childcare and SA Branch; Dates: 7/1/17 - 8/30/17. <br />Additional Insured(s): The City of Santa Ana, its officers, employees, agents and volunteers. <br />\00) <br />CERTIFICATE HOLDER CANCELI ATION <br />The C1% of Santa Ana <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of anta Ana Commuity Development <br />THEEXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Agency(M-25) <br />20 Civic Center Plaza <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92701 <br />Candice Solarz J <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />1076s470 110-19 cL Aoxo EXCESS 18 19 WC I Nancy cadwzIlader I 3/9/20le 1:22:25 Pm (Pri I Page 1 of 4 <br />