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ACO ® CERTIFICATE OF LIABILITY INSURANCE <br />DAE09124120192412019 <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(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 />Comprehensive Insurance Services <br />26429 Rancho Parkway South <br />Stine 120 <br />Lake Forest CA 92630 <br />NAME: Cemficate Issuance Team <br />xf PHONE (949) 709-8800 A%q No (949) 709-1668 <br />AK No . A <br />ADORESSo jerenry@thecomprehensiveinsurance.com <br />INSURERS) AFFORDING COVERAGE <br />NAIC a <br />INSURERA: Nonprofits Insurance Alliance of California <br />10023 <br />INSURED / <br />Community Health Initiative of Orange County V <br />1505 E. 17th Street. Suite 121 <br />Santa Ana CA 02705 <br />INSURER B: <br />INSURER C: <br />INSURER D <br />INSURER E : <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: CLI992404255 REVISION NUMBER: <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. LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR LTR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />MMIDOIyYVY <br />M <br />L1MIT8 <br />OO1rM / ERCIAL GENERAL UABIUI: <br />EACH OCCURRENCE <br />s 1.000.000 <br />CINN&MADE I ><I OCCUR <br />✓ <br />✓ <br />PREMIS S Ea Pe ierenn <br />s 500.000 <br />MEDEXP(An ere, n ) <br />s 20,000 <br />A <br />Y <br />2019- 4927 <br />1011512019 <br />10115t2020 <br />PERSONALa AOVINJURY <br />$ 1.000,000 <br />GEM AGGREGATE UMITAPPUES PER <br />GENERALAGGREGATE <br />s 2•000•0000 <br />PRODUCTS - COMPIOP AGO <br />s 2,000,000 <br />POLICY ❑ 3E T © LOD <br />80 Deductible <br />s <br />OTHER , <br />AUTOMOBXf UABIUTY <br />COMBINED L LIMIT <br />EA acc 1 <br />s 1,000,000 <br />BODILYINJURY(PWPerson) <br />s <br />ANYAUTO <br />BODILY INJURY tw.aMw10 <br />S <br />A <br />OWNED SCHEDULED <br />AUTOSONLY AUTOS <br />HIRED NON.OWNE <br />AUTOS ONLY AUTOS ONLLDY <br />201g-44927 <br />10/15/2019 <br />10115/2020 <br />-Rb7FnTVNUAGE <br />Pet <br />S <br />$O Deductible <br />s <br />UMBREL UAB <br />OCCUR <br />EACH OCCURRENCE <br />AGGREGATE <br />S <br />EXCESS UA1B <br />CLAIMS -MADE <br />DED <br />I I RETENTION s <br />S <br />WORKERS COMPENSATION <br />AND EMPLOYERS'UABIUYIN LIABILITY <br />^NVCERIMEETOR RIEItECUTIVE <br />I PER T14 <br />STATUTE eOR <br />EL EACH ACCIDENT <br />s <br />EL DISEASE - EA EMPLOYEE <br />s <br />EXCLUDED' <br />FFIOERAIEMBER E%CWDED+ <br />jaanaatory WNH) <br />NIA <br />EL pSEASE- PDLICY LIMIT <br />S <br />I yet itterbe under <br />JESCRIPTIORIPTgN OF OPEMTONS eYw. <br />$1,000,00011,000.000 <br />AggregatelOcc <br />A <br />Social Service Professional <br />Improper Sexual Conduct <br />2019-44927 <br />IOMS2019 <br />10/1512020 <br />$1,000.00W1,000,ODO <br />AggregatelOcc <br />$0 Deductible <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101. A44kienal Remarks SCM1tee M adule. may tMCH4 Of more space is n,wirs4l <br />City of Santa Ana, its officers. employees. agents and volunteers are included as Addit*ml Insured automatically per written contract or agreem per / <br />attached endorsement CG2026. 0 day notice of cancellation with 10 day notice of cancellation for non-payment of premium per policy provision. This t/ <br />Insurance is Primary and Non-contributory per attached endorsement NIAC E61. <br />IFI#z�# 2020 <br />City of Santa Ana <br />Risk Management Division ✓ NC11E ACEVEdO <br />20 Civic Center Plaza <br />Santa Ana CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED <br />m 14AA.9n15 AGOR❑ CORPORATION. All riDhts reserved <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />