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a DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 7/1/2020 7I1/20I9 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 Lockton Insurance Brokers, LLC CONTACT NAME: 777 S. Figueroa Street, 52nd Fl. PHONE FAX CA License #OF15767 E-MAIL IAIC. Nat: Los Angeles CA 90017 ADDRESS: (213) 689-0065 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Philadelphia Indemnity Insurance Co. 18058 INSURED Community SeniorServ, Inc. INSURER B : Redwood Fire and Casual Insurance Co 11673 1448916 1200 N. Knollwood Cir. INSURER C : Anaheim CA 92801 INSURER D : INSURER E : INSURER F : COVFRAr.FS f'i MV1Ff11 nFRTIFI/'ATF NIIMRI=R• 1 9A7A17A RFVICInKI NI IMRFR• YYX3IXYX 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 ADDL SUeR POLICY EFF FLICY EEXP TR TYPE OF INSURANCE INSD VI1VQ POLICY NUMBER IMMIDWYYYY1 (MMIDDrAYY)LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y N PHPK2005119 7/]/2019 7/1/2020 EACH OCCURRENCE PRE,MIS—E$,Aaff.tEB ocRENau an" $ 1000,000 $ 1 000 000 $ 20 0-00. MED EXP (Any one person _ PERSONAL & ADV INJURY $ 1-000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY PRO- {� JECT 1� LOC PRODUCTS - COMP/OP AGG $ 3,000,000 A AUTOMOBILE LIABILITY N N PHPK2005119 7/1/2019 7/l/2020 '.O OINFIBtSINra MIT $ 1,.000QQQ. BODILY INJURY (Per person) $ XXXXXXX ANY AUTO OWNED SCHED AUTOS ONLY AUTOSULED I BODILY INJURY (Per accident) $ XXXXXXX _ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAM4GE Pgr accl n $ XXXXXXX $ 1,000 A UMBRELLA LIAB X OCCUR N N PHUB683732 7/1/2019 7/l/2020 EACH OCCURRENCE $ 10 000 OOO JX AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $ 10.000 $ B WORKERS COMP LI TIOIN YIN AND ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F_N] (Mandatory in NH) N / A N COWC034033 7/l/2019 7/1/2020 PER O- X � TH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S) REFERENCED_ The City of Santa Ana, its officers, employees, aganN, roprcyentutives and volunteers are an Additional Insured to the extent provided by the policy language or endorsement issued or approved by the insulunee apl � yr trp rirll il3t1p]�lyhtSurcd(z) is primary and non-contributory as per the attached endorsements or policy language. ��i�CtVy �j� OlR �JlGLI By Ri$k MANAGEMENT Divi$iON A_ L 17 2019 L;R=K I II-It;A I L HULut_K NC:t=LLA I IUN Nee Attachment 15476274 AM NTHA M. LAMBE The City of Santa Ana, Risk Management SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 Civic Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR n 14RR.7n14,7lCr317r) CORPORATION_ All rinhtw rPCPrvPd_ ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD