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CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDAYYY) <br />1 p/1/2018 <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($), 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 endorsed. <br />If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement, A statement on <br />this Certificate does not confer rl hts to the certificate holder in lieu of such enciorsement(s). <br />PRODUCER <br />Arthur J, Gallagher Bt CO. <br />Insurance Brokers of GA. LIC.00726293 <br />505 N Brand Blvd, Suite 600 <br />rvamIT <br />e:o Annie Lee <br />P ONE Fq <br />818.639.8001 AI No:818.839.s709 <br />L • Annie Lee a •com <br />11 AFFORDINGOOVERAOS <br />NA)Ce <br />Glendale CA91203 <br />WSURSRA; Great American Alliance lnaurance Cc <br />26832 <br />INSURED ORANCOU•19 <br />Orange County Conservation Corps <br />1853 N. Raymond MS. <br />Anaheim, CA 92801 <br />INSURER a l Great American Insurance Company of NY <br />22135 <br />INSURERa: NonProfits United <br />wsuRERD: Navl ators Insurance Company.42307 <br />INSURER E: <br />COVERAGES CERTIFICATE NUMBER:8$7487771 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LI57E0 BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS.AND CONDITIONS OF. SUCH. POLICIESLIMITS SHOWN MAY HAVE BEEN REDUCED BY _PAID CLAIMS. <br />T <br />TYPE OF INSURANCE <br />PO <br />ADPF <br />LIMITS <br />A <br />X <br />COMMEROIALOENBRALLIAHILITY <br />Y <br />PAC 810460D 14 <br />10M/2010 <br />10/1/2019 <br />EACH OCCURRENCE <br />111,900,000 <br />CLAIMS -MADE OCCUR <br />PREMISED (En accurm ce <br />-„ <br />$IAA OAO <br />MED EXP (Any o119 Peracn) <br />$ 8,000 <br />PERSONAL& ADV INJURY <br />$1000.000 <br />GENT AOOREGATE LIMITAPPLIES PER <br />GENERALAGGREGATE <br />$3000.000 <br />PRODUCTS - COMPIOP AGO <br />$a,0001000 <br />X PO(.IOY D JEW 171LOO <br />$ <br />OTHER: <br />B <br />AUTOMODILELIABILITY <br />CAP 090124008 <br />10/l/2010 <br />101112o19 <br />M%M=ftfL_$1.000,000 <br />$ <br />X ANYAUro <br />BODILY INJURY(Perparaan) <br />OWNED SCHEDULED <br />AUTOS ONLYNxAUTOS <br />X AUTOS DNLY AU708 ONLY <br />SonILY I NJURY(Par opmenp <br />$ <br />P APccrJe IDAMAGE <br />-- <br />$ <br />$ <br />X C.M01 0 CoA$S00 <br />A <br />X <br />UMBRELLA LIAD <br />X OCCUR <br />UMS cSW79614 <br />101112MB <br />10(1/7.019 <br />EACH OCCURRENCE <br />$4000000 <br />AOGRSUATE <br />$4000000 <br />RX9B83 LIAE <br />CLAIMS.MADE <br />DE X <br />I RETENTION94QMQqq <br />$ <br />O <br />WORKERS COMPENSATION <br />AND EMPLOYERS -LIABILITY <br />AFPROPR MOEREATNERMXECUTIVE YI rNi <br />(Mandatoryln NH) <br />If yB§, de1011bounnor <br />DESCRIPTION OF OPERATIONS WQW <br />NIA <br />NPU-WCG001-2016 <br />1/112019 <br />1/1P2019 <br />X SATUTE <br />E.L. EACH ACCIDENT <br />_ <br />$ 000,000 <br />E.L. DISEASE- PA EMPLOYE <br />$1.000,00o <br />EL,DISEAaE-POUCYLIMIr <br />81000,000 <br />O <br />Directors&DflloPrg <br />NYIBUOLV03161NV <br />10MIDDID <br />'IDI1/20IR <br />Pell OlahPo <br />Aggrepdte: <br />$2,000.000 <br />92,000,000 <br />DESCRIPTION Ok OPEItATIONS I LOCATIONS IVeHIOLR$ IADDRD 101. Additional Remarks schedule, may he Aaarhod if maro apace fa regairod) <br />Policy � AbUSD and molestation Coverage <br />Policy s; PAC 515408014 <br />Term: 10/0ea 018 -1010 Alliance Insurance Co, NAIC; 28832 <br />Term; 10/01 /2p18-1 D/0172019 <br />Each Occ : $1 OD0,000 <br />Aggregate :$9,000,000 Reviewed by Audrey Goodson Page of <br />ROIIPy' Professional Liability <br />See Attached,,. <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />City of Santa Ana, Workforce Investment Board <br />1000'E. Santa Ana Blvd., Ste. 200 <br />Santa Ana CA 92701 <br />AUTHORIZEDREP ASENTATIVE <br />A' AI <br />® 1988-20$ AGORD CORPORATIOM All rights reserved. <br />ACORD 26 (2D1S/0$) The ACORO name and logo sea registered marks ofACORD <br />