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<br />ii CERTIFICATE OF LIABILITY INSURANCE on 07/0512010vvl
<br />�-�"� _ 07/05f201g
<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(B), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(los) must bo endorsod. If SUBROGATION IS WAIVED, subject to lho
<br />terms and condillons of the PDIICy, contain pollcios may require an endorsement. A statement on this certificate does not senior rights to the
<br />certificate holder In Ilan of such endorsomanHsl.
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<br />Dickerson Insurance Services, License MOM29112
<br />n11onE.. AR - ----'"
<br />WM Nc a%p (028)!IGD 237d- In+o,plq.
<br />f 018 Riverside Drive
<br />erAAIL RoddgolIIl(IIcY,eTSWn,gmup.DOn1
<br />numiEss
<br />Angeles CA 90039
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<br />(32 )662.7
<br />(02316624200
<br />IRSURErgg]AI PbR01N0CpVEIkALE IIAICN
<br />iq!tUil BA P11dgj0lpl11a lFldunlglly hleOrari Company 21oAA
<br />INSURED
<br />Charitable Ventures of Orange County
<br />INsulUp a Nr W Yorlt Mallno & Gonm 11 1naurdn@s Com mp I6000
<br />J Y. _
<br />4041 MacArthur Blvd , SUIR 510
<br />Newport, CA 02560
<br />INSU81T 0:
<br />INGVREN E:
<br />INSURER P 1 ;
<br />COVERAGES CERTIFICATE NIIMRFR•
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<br />Tills IS TO DERTIFY TFIAT 1'HE POLICIES OF INSURANCE LISTED BELOW HAVE BCEN ISSUCD TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RE$PFCT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE_ AFFORDED BY TFIE POLICICS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
<br />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />LTR TYPEOFINSVMNGEINITS, wyn POLICY NUMBER IA 1110111YYYYIIIM In'YVVI
<br />LIMITG
<br />GENERAL LIABILITY
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<br />ii C_OIAMCAGAI GENERAL LIABILITY
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<br />EACH OCCURRENCE
<br />nT111GF 70LLoSE"D
<br />MEDeXPVIy.1.IIncl
<br />MED E%P 1AIyOnaP1 )
<br />$ 1,000,000
<br />S„t011opp_
<br />55,000
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<br />PI-IPK1900984
<br />07115/2019
<br />07/15/2020
<br />PERSONAL a AOVINUQRY
<br />s1,000.000 .
<br />GENERAL AGGREGATE
<br />S 2,000,060
<br />GEN'L AGGREGATE LIMIT APPLIES PER.
<br />x II POLICY 0. LOC
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<br />P1lODUCr5-GOIAPrOPAGD
<br />52,00Q090,
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<br />PHPK19fl0954
<br />07/15/2019
<br />07/15/202(1
<br />DOONBODILY INJURY (Per Pvrsen)
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<br />00011-Y INJURY(Pnr acculvnll
<br />PROPIiR190 MAG6
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<br />S 4.000,000
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<br />I E%CCSSLIAD I CLAPUS-IJr LE
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<br />PHUB678897
<br />07/1512019ftG7/15/202C
<br />IGREGATE - _
<br />5 4,000,000
<br />.Y
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<br />WOnNERS COMPENaAT10N '-
<br />AND EMPLOYEI35'LIADILIN YIN
<br />ANY PROPRICTORIPARTNER EXECDTIVE
<br />B OFI ICEIMEMBER EXCLUDED? � NIA � WC201900011225 07/15/2019
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<br />EACHACCIOEPIT 31,000Nlll DIGr'ASEEA EMPLOYE' =yea,&l,,alo
<br />-------- -
<br />Dll,. POLICY LIIAII $ 1,000000
<br />I�F—
<br />DBGGRIPTION OF OPGRAlIONSILOL'A9DNBIV[RICLEa (Allneb ACORD 101, AJBllloi Irt nerkv ScaoJulo Ir more anoco la ragnmdl
<br />I'
<br />�__�W
<br />RE: Summer Night Lights Program
<br />City of Santa Ana, olf Edi agents, employees, and volunteers are named as additionally insured on this policy pursuant
<br />to written contract, agreement. or
<br />memorandum of understanding. Such insurance as Is afforded by IIgG policy shall be primary, and any insurance carried by City shall he ex)d excess an
<br />noncontributory. Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation,
<br />REVIEWED C71 A PPROVEO
<br />By RISk MANAGEMENT DIVISION
<br />WrM;lrIW,A IC rR,?L. at CANCELLATION -&7117t1
<br />City Of Santa Ana SHOULD ANY OF THE ABOVE DESCAtALLLa- `w.l
<br />0 THE EXPIRATION DATE THGREOf('(y'SG F I WItt IY3f5/i�[Y..IYC11fEpt y l•I
<br />Risk Melia Olnent Division ACCORDANCE WITH THE POLICY PRWISiGT I, IVG EA YI LJi1`G/lL
<br />20 Civic fenlor Plaza.,._
<br />AVTI10nIEE0 REPREGENTATIVE
<br />Santa Ana CA 92702 1
<br />Rodrigo Banuelos
<br />L
<br />@11988.2010 ACORD CORPORATION. All rights reserved,
<br />AUUi 40;4UTVIUDI I he AUORD name and logo are registered marks of ACORD
<br />
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