|
A� H CERTIFICATE OF LIABILITY INSURANCE
<br />DA )
<br />1(/01201
<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 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 policy(ies) 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
<br />CONTACT Certificate Issuance Team
<br />NAME:
<br />Comprehensive Insurance Services
<br />AICNNo (949) 709-8800 FAX(949) 709-1668
<br />Ext: No:
<br />26429 Rancho Parkway South
<br />E-MAIL Jeremy@thecomprehensiveinsurance.com
<br />ADDRESS:
<br />Suite 120
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIL#
<br />Lake Forest CA 92630
<br />INSURERA: Nonprofits Insurance Alliance of California
<br />10023
<br />INSURED
<br />INSURERS: CompWest Insurance Company
<br />12177
<br />Delhi Center
<br />INSURER C :
<br />505 E. Cenlml Ave.
<br />INSURERD:
<br />INSURER E:
<br />Santa Ana CA 92707
<br />1 INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: CLI911404352 REVISION NUMBER:
<br />THIS ISTO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMEDABOVE FORTHE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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 />R
<br />TYPE OF
<br />DIED
<br />WVD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDDfYYYY
<br />POLICY UP
<br />MMIDDIYYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE 7x OCCUR
<br />°
<br />PREMISES Ea occurrence
<br />$ 500,000
<br />MED EXP Any one person)
<br />$ 20,000
<br />PERSONAL B ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />201MI376
<br />11/01/2019
<br />11/01/2020
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$ 3,000,000
<br />P"_ FX LOC
<br />POLICY JECT
<br />PRODUCTS -COMP/OPAGG
<br />$ 3,000,000
<br />OTHER:
<br />$0 Deductible
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMN
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />2019-01376
<br />11/01/2019
<br />11/01/2020
<br />BODILY INJURY (Par accident)
<br />$
<br />X
<br />HIRED NON -OWNED
<br />H
<br />PROPERTY DAMAGE
<br />$
<br />AUTOS ONLY AUTOS ONLY
<br />Per accident
<br />$0 Deductible
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />TIED I I RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />PER OT H-
<br />!�
<br />$0 Deductible
<br />AND EMPLOYERS' LIABILITY yl N
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />B
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE El
<br />WCV590042004
<br />11/01/2019
<br />11/01/2020
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />E.L DISEASE - EA EMPLOYEE
<br />1,000,000
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />$3.000,000/1,000,000
<br />Aggregate/Occum.
<br />Social Service Professional Liability
<br />A
<br />Impmper Sexual Conduct Liability
<br />2019-01376
<br />11/01/2019
<br />11/01/2020
<br />$1,000,000/1,000,000
<br />Aggregate/Occurr.
<br />$0 Deductible
<br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached IT mom space is required)
<br />l
<br />City of Santa Ana, officers, agents, employees, and volunteers are named as add goaljyLlr L�nyjhI to written contract, agreement, or
<br />memorandum of understanding per attached endorsement CG2026. Such insura CC t & primary, and any insurance carried
<br />by City shall be excess and noncontributory per attached endorsement NIAC E61 Bf R%k*Mr9fi"W(D1Vl§j ay notice of cancellation for
<br />1
<br />non-payment of premium per policy provision.
<br />EB
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702
<br />i
<br />@ 1988.2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|