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<br />CERTIFICATE OF LIABILITY INSURANCE
<br />D20/03/2019
<br />30/03/2019
<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 poiicy(les) 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 />thiscertificate does not confer rights to the certificate holder in Ileu of such endorsements ,..
<br />PRODUCER ..
<br />Willie Towers Watson Insurance Services West, Inc. fka Willis
<br />Insurance services of California, Inc.
<br />c/o 26 Century Blvd
<br />- RANKS___. _...
<br />I10NE 1-U77 945-7370
<br />(1�E oC Lffl&A;
<br />'EM
<br />--'_'
<br />AIL,eD BESS:.. cartifloatas@willia.com _..
<br />INSURERS AFFORDING COVERAGE
<br />-- -- ----•Insu �----_---_
<br />P.O. Sox 305191
<br />Nashville, TN 372305191 USA
<br />Company
<br />INSURER A: L®xington Inavranca Company
<br />19437
<br />1943
<br />INSVRED
<br />The salvation Army, -Division 11
<br />INSURERD; Greenwich Insurance Company
<br />--�—
<br />22322
<br />ryl eURERC;. HI'.8peoialty Insurance Company
<br />37885
<br />30840 Hawthorne Blvd., Bldg D
<br />INSURERD; - -
<br />Rancho Palos Verdes, CA 90275 -
<br />INSUR RF
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE iISTEDBELOW HAVE BEENISSUED?0 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS..
<br />iNTR —�
<br />�
<br />OFINSURANCE AITdL BBA adifi:Y:SfF-.:OLI'OY'@"`
<br />..TYPE - tl POMCYN4 D�R
<br />K
<br />COMMERCIAL GENERAL LIABILITY-
<br />--�
<br />EACH OCCURRENCE
<br />$,` 2,000,000
<br />l
<br />"..pl CLAIMS MADE Lx�. OCCUR
<br />MA2iE9'0RENTEG
<br />k'.isEM €$SEflP5Eo3€HSR1._
<br />$— 1,000 000
<br />A
<br />X
<br />sTR: 4500,000 Par Occurrence
<br />VIED E%P none erasn
<br />$. 0
<br />_
<br />y
<br />027712409
<br />10/01/201910/01/2020�-P——�"-'"
<br />PERSONAL INJURY
<br />$ 21000,000
<br />AGGREGATE -.
<br />,$ 4 000, OOD
<br />GENII,
<br />A00AE''G''""ATTIIE LIMIT APPUCB PER:
<br />.GENERAL
<br />Policy a] LOC
<br />I,_J JFCT
<br />PRODUCTS-COMPIOP AGO
<br />$ 4,000,000
<br />�
<br />$
<br />,..
<br />0 iGR
<br />�^
<br />AIITOMOEILE
<br />LIABILITY
<br />4R GIIEJ] IN CLIMIT"
<br />a af.Udgn9 _:
<br />$ 5,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Par person)'
<br />_
<br />$
<br />B
<br />-
<br />OWNED SCHEDULED
<br />AUTOS ONLY - AUTOS
<br />y
<br />M5000215-09
<br />10/01/2019
<br />10/01/2020
<br />BODILY INJURY Par accltlenl
<br />(
<br />$ --
<br />HIRED NON -OWNED
<br />PRO•�
<br />pROPCRTYbr1MAGE
<br />—Y DAMAGE
<br />_
<br />AUTOS ONLY —; AUTOS ONLY
<br />$
<br />UMBRELLA LIAR _ OCCUR
<br />EACH OCCURRENCE ...
<br />$.
<br />EXCESS LIAe CIAIMB•MAOE
<br />a
<br />AGGREGATE
<br />$
<br />�-
<br />OEM_ .RETENTION
<br />-
<br />_.
<br />COMPENSATION
<br />AND EMPSYERSLIILIT
<br />ANDEMPLOYER&LIABILITY
<br />I DIH-
<br />YIN
<br />C
<br />ANYOFFICERIM
<br />Y
<br />E.L. EACH AGCIDEM
<br />$ 1, 000, 000
<br />MBER XCOUDIEXECUTIVE
<br />0EREXCLDDED7
<br />NIA
<br />RWD5000217-09
<br />10/01/201910/01/2020
<br />(Mandatory
<br />(Mandatary In NH)
<br />E.L.I--------------��1,,.__.._6ro
<br />E.L. DISEASE- FA EMPLOYEE
<br />E 1, 000, 000
<br />DESCRIPTION OF OPERATIONS below
<br />.�
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />Excess Workers Compensation
<br />Y
<br />RWE500021609
<br />10/01/2019
<br />10/01/2020
<br />E. L• ¢soh Accident
<br />1$1, pD0, D00
<br />$1,000,000
<br />and Employed. Liability
<br />E,L,: Disease Pol Lim
<br />$1,000,000
<br />WC - Per Statute
<br />E,L, Disease - Be E
<br />$1,000,000
<br />DESCRIPTION DP OPERATIONS I LOCATIONS I VEHICLES(ACORD101, Additional Roanwhs Schedule, maybe attached ifmorespacs larmulbd) Y
<br />Division 011-148
<br />Workers Compensation:
<br />Policy No, RWD5000217-09 provides coverage in the following states: HI,ID,MT,NM,NV,TX,UT
<br />Policy No. RWE500021609 provides coverage in the following states: AE,CO,OR
<br />SEE ATTACHED
<br />By Risk MANACE61ENf DIVISION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />,f5y Q ACCORDANCE WITH THE POLICY PROVISIONS,
<br />City of Santa Ana T 0 `• ...
<br />Risk Management Division -
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic center Plaza MOM P. VILLAREAL ,��i�0
<br />Santa Ana, CA 927D2
<br />©1988.2016 ACORD CORPORATION. All Tights reserved
<br />AUVRU zs ([U16Iu3) The ACORD name and logo are registered marks of ACORD
<br />So 10: 18625509 snres: 1395017
<br />
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