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CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S}, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certiflcate holder is an ADDITIONAL INSURED, the policyI ies) must have ADDITIONAL INSURED provisions or be ondorsed. If SUBROGATION IS WAIVED, subject to Ahe farms and conditions of the Policy, certain policies may require an endorsement. A statement on this certificate dons not canter rights tot a Certificate holder In lieu of such ondorsement s . PRODUCER I 0 TACT Arthur J. Gallagher & Co, i NAME KIm Tran ._._.. PHONE Insurance Brokers of CA Inc. LIC #07?.6293 c Nu €xt 618.530,$616 A538se77 505 N Brand Blvd, Suite 600 1 �o'e kim tran a com _. Glendale CA 91203 % BSgQA°.----- --...- INSURED _-- Community Action Partnership of 11870 Monarch Street Garden Grove, CA 92841 THIS INDICATED. CERTIFICATE EXCLUSIONS INSR Lm -- IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUf�p2EMENT, MAY BE ISSUED OR NIAY AND CONDITIONS OF SUCH �'—_ TYPE OP INSURANCE ^� F`IN: .' OFi' INSURANCE PER, POL)CIES.. AD a 9Ri'-' YYY ' ,..=,. woo M OR BELOW HAVE BEEN ISSUED TOTHE TERM OR CONDITION OF ANY CONTRACT THE INSURANCE AFFORDED BY THE POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY ---�_._... POLIC. F POLICYNUMBER MID � INSURED OR OTHER DESCRIBED PAID CLAIMS. POLICY FJfP"^----- DDM REVISION NUMBER;. NAMED ABOVE FOR THE bOCUMENT WITH RESPECT HEREIN IS SUBJECT TO LIMITS POLICY PERIOD TO WHICH THIS ALL THE TERMS, COMMERCIAL GENERAL LIABILITY CLAIMS.MADE �l OCCUR � EACHOCCURRENCE I"DAMAD'E'tt5'R�FaTaD` $ EMISS Ee ofperrence 3 it IIIIII _MED E'(, P fAn unPPeretin _S GEN'L AGGREGATELIMIT APPLIES PER i PERSONALS,AOV INJURY $�` - _-- �jECOT �LOC GENERALAbGREOATE $ OTHER;POLICY OTHER; ': PRODUCTS-COMP/OP Aga $ ---------.--... AUTOMOBILE LIABILITY Y C MBIN�O INGLE LIMIT $ ANY AUTO i i€9.9&�tlaOlL�. •$ OWNED "' SCHEDULED BDDILYINJURY (Per person) �.___ $ _ AU7DS ONLYAVTOS HIRED NON -OWNED BDDILY INJURY Pereccldent) ( ti,_,.,„,.,__,_, _ $ AUTOS ONLY -AUTOS ONLY i PROPERTY DAMAGE - _ _ UMBRELLAUAS OCCUR 1 S EXCESS WAB� OUiIMS-MADE I• EACH OCCURRENCE $ .....�_ - ---- .._""'_.'I DED RETENTIONS i AGGREGATE "' S ------- - A WORKBR3 COMPENSATION AND EMPLOYERS' LIABILITY COWC034076 , 7/1/2019 7/1/2020 X PE $ YIN ANYPROPRIETORIPARTNER7EXECUTIVff ( STATUTE ER - ---- OFPIpERaJEMaEReXCLUOED9 (Mandatory In NHl NIA ' E.L. EACH ACCIDENT —_.... S1 Dp0000 e� If yyes tloocdbe undo. DESC IPTION OF OPERATIONS bel L ALL DISEASE -EA EMPLOYEE 51000,00e _ e , E.L. DISEASE, POLICY LIMIT $ 1 000,000 DESCRIPTIEvidence of covrageOPERATIONS l LOCATIONS (VEHICLES (ACpRD tei, Additional Remarks Schedule, may ba attached if morn apaco la rm uiame EVIdBRCB O( COVBraQB. , REVIE! D & APPROVED Risk AGEMENT DIVISiON CERTIFICATE HOLDER I I ,..,,„«.. ._. _.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Santa Ana SAMANT , IAflfflffirNCE WITH THE POLICY PROVISIONS. Risk Management Division 20 Civic Center Plaza, 41h floor, AUTHORIMDReP ESENTArivs Santa Ana CA 92702 t l ACORD 26 2016/03 • C ORD The ACORD name and logo are registered markkss of f ACQRD