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DocuSign Envelope ID: D62396E7-5ACC-4072-B2AC•195DF71421E2 <br />ACORD 0 CERTIFICATE OF LIABILITY INSURANCE <br />DATE YI <br />li <br />06wpU220 <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 />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sj. AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be andomed. <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 endoreement(s). <br />FROOUCER <br />NAME Carmenoita Josef <br />PxONE (009) 243-8200 243.8-820t <br />Hays Companies Inc. <br />AooREss. cjosef@hayscompanies com <br />4200 Contours, Suite a350 <br />INSURE S AFFORDING COVERAGE <br />NAIC F <br />INSURER A Philadelphia Indemnity Ins Co <br />Onu no CA 91764 <br />INSURED <br />INSURERB Insurance Company of the West <br />INSURER C <br />Boys 8 Girls Clubs of Central Orange Coast <br />17701 Cowan. Suite 110 <br />INSURER D <br />INSURER E <br />INSURER <br />Ovme CA 92614 <br />COVERAGES CERTIFICATE NUMBER: CL206197038 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVIE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED NOTWITHSTANDING ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICHTHIS <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 />TR <br />TYPE OF WSUI2AMCE <br />POLICY NUMBER <br />MWDD/YYYY <br />MIND <br />LINTS <br />COMMERCIAL EIIIEaAL U WLRY <br />/ <br />/ <br />✓ <br />EACH OCCURRENCE <br />5 i •555.w0 <br />PREMISES$ <br />100.000 <br />CWMSMADE ® OCCUR <br />5.000 <br />Professional Liability <br />MEO EXP (Anyfine onl ee. <br />S <br />Sexual Misconduct <br />PERSONAL a ADV INJURY <br />s 1.000.000 <br />A <br />Y <br />PHPK2125850 <br />04/0112020 <br />06/012021 <br />GENL AGGREGATE UNIT APPLIES PER <br />GENERALAGGREGATE <br />s 3•000•000 <br />POLICY ❑ JEECCT LOC <br />PRODUCTS -COMP,0P AGG <br />s 3.DDO.000 <br />It <br />OTHER <br />AUTOMOBILE <br />LIABILITY <br />COMBNED SINGLELIMIT <br />s 1,000,000 <br />x <br />ANYAUTO <br />BODILY INJURY W. PMBom <br />S <br />A <br />OPINED SCHEOIAEo <br />AUTO&Y AUTOS <br />PHPK2125850 <br />04101/2020 <br />06Vt202I <br />sODayiwu"IN'axwalu <br />S <br />HIRED NON-0Nwo <br />A <br />Ipw <br />j <br />AUTO$ONLY AUTOS ONLY <br />s <br />UMBRELLA LIAO <br />«CUR <br />EACH OCCURRENCE <br />$ 5,000.000 <br />AGGREGATE <br />$ 5.000.000 <br />A <br />EXCESS LIAO <br />CI,NMS,ANDE <br />PHUB719908 <br />04101r2020 <br />06/012021 <br />OED <br />RETENTION s 10.000 <br />S <br />KER9 COMPE"MON <br />FvEMPLOYERS <br />LIABILT' Y1N <br />r/ <br />TATBPROPRIETDRNARTNEREXECUTIVE <br />EL EACH ACCIDENT <br />1 1,OIXL000CEmMEMBER <br />F�F <br />NIA <br />GAVE 505577300 <br />06A72020 <br />06/012021 <br />EL DISEASE -EA EMPLOYEE <br />5 1.000,000 <br />EXCLUDEW <br />darwy lA NH) <br />. Ileum tulbeI.D00,000 <br />CRIPHONOFOPERATIONSCWAv <br />E.L. DISEASE - POLICY LIMIT <br />j <br />Blanket BPP <br />$921.000 <br />Property-Replacemenl Cost <br />A <br />Special Farm <br />PHPK21258W <br />041012020 <br />06/01/2021 <br />Deductible: $1.000 <br />OESCRtP N OF OPEUVMS I LOCATXINS I VEHICLES IACORD 1a1, AddMNnM RMnMYa $tlladlla, may b aeaPNad 11 more apxa N raaul.e41 <br />City of Santa Ana. officersagents. employees and volunteers are additional Insured on the General Liability only per carmen contract agreement or <br />✓ <br />memorandum of understanding. Policy Is Is primary and and any insurance Carried by City shall be excess and non contributory <br />REVIEWED & APP <br />30 day cancellation except 10 days for non payment of premiurI By RI51L MAN ^,r.FMENT <br />CERTIFICATE HOLDER <br />CANCELLATION <br />OVEE <br />(IVISION <br />LA • e u' A 1 <br />M <br />Mils" i�L�l0 <br />a <br />SHOULD ANY OF THE ABOVE DESCRIBED POLIO <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ara - Risk Management Division <br />ACCORDANCE WITH THE POLICY PROVISIONS <br />20 CIY¢ Center Rana <br />AUTHORUEO REPRESENTATIVE <br />Santa Ana CA 92702 <br />(\AAaI <br />O 1988.2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />