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�At <br />`�� a CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) <br />12/30/2019 <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 NEGATIVELY AMEND, EXTEND ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE INSURANCEE DOES NOT CONSTITUTE A CONTRTR ACT 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 Bolton & Company <br />3475 E. Foothill Blvd., Suite 100 <br />Pasadena, CA 91107 <br />NAMEACT <br />PHONE szs 799-7000 FAX <br />.MJfbiaAILExtc ANo: 626 583 2117 <br />ADDRwwwbESS <br />INS URER$AFFORDING COVERAGE <br />INSURER A: The Hanover American Insurance Company <br />INSURER B: Qualitycomp Inc. <br />NAICd <br />36064 <br />INSURE0 0ltonCO.COm 0008309 <br />N$11RE <br />YMCA of Orange County <br />13821 Newport Avenue Suite 200 <br />Tustin CA 92780 <br />INSURER C: <br />INSURER D: <br />NSURER E <br />NSURERF: <br />Crl1/FQAGCC <br />mmvIDIUN NUML$BR: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED <br />ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRI8ED HEREIN IS <br />TO WHICH THIS <br />EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS. <br />SUBJECT TO ALL THE TERMS, <br />INSR ADDL BUYS <br />LTR TYPE OF INSURANCE POLICYNUMBER MM/OpY EFF MMIOpY EXP <br />LIMITS <br />A / COMMERCIALOENERAI LIABILITY ✓ ZZ3D79134001 1/1/2020 1/1/2021 <br />CLAIM&MADE MOCCUR <br />EACHOCCURRENCE <br />O­AlvPREMISES <br />$1000000 <br />Ea escu renre <br />$1 000 000 <br />Includes Sexual Abuse Coverage <br />MED EXP Any see person <br />$20000 <br />PERSONAL&ADVINJURY <br />$1 000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO- ❑ <br />GENERALAGGREGATE <br />s2,000,000 <br />JECT LOC <br />PRODUCTS-COMPIOP AGG <br />$2000000 <br />OTHER: <br />s <br />A <br />AUTOMOBILE <br />LIABILITY <br />AW3D79131301 <br />1/1/2020 <br />1/1/2021 <br />COMBINED INGLELIMm <br />ANYAUTO <br />Ea 'am <br />$1,000,000 <br />BODILY INJURY(Perperson) <br />s <br />OWNED SCHEDULED <br />ONLY AUTOS <br />BODILY INJURY (Per acddent) <br />$ <br />HIRED <br />HIRED NON-OWNEDSLY <br />AUTOS ONLY AUTOS ONLY <br />PROPERTYDAMAGE <br />IF.,aCciden[ <br />$ <br />$ <br />A <br />✓ <br />UMBRELLA LIAa <br />OCCUR <br />UH3D79134101 <br />1/i/2020 <br />i/1/2021 <br />EACHOCCURRENCE <br />$75OOO OOO <br />EXCESS LIAR <br />CLAIMS -MADE <br />AGGREGATE <br />$15 000 000 <br />DEED RETENTIONS <br />B <br />WORKERS COMPENSATION <br />0150820317 <br />1/1/2020 <br />1/1/2021 <br />PER DTH- <br />$ <br />AND EMPLOYERS'LIABR-ITN YIN <br />✓ STATtfTE ER <br />ANYPROPRIETORIPARTNERIEXECUnVE <br />OFFICERIMEMBEREXCLUDED? � <br />NIA <br />EL. EACH ACCIDENT <br />$1,000 DDD <br />andaloryth NH) <br />EL. DISEASE EA EMPLOYE <br />$ <br />If <br />If yes, describe Linear <br />DESCRIPTION OF OPERATIONS hot. <br />E.L. DISEASEPOLICYLIMIT <br />$1000000 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) <br />GL Additional Insured and Primary & Non -Contributory Wording apply per 42129150615 attached, only if required <br />Cancella9on Clause applies per IL00171198 attached. <br />by written contract/agreement.GL <br />Re: Operations of the Named Insured. Additional Insured(s): City of Santa Ana. <br />r PQTICIr ATC Lint nCD _...__.. ._._.. <br />City of Santa Ana REVIEWED & APPROVED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Risk Management Division By RISK MANAGEMENT DIVISION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />Debra Roses V "a <br />©1988-2015 ACORD CORPORATION. All rights reserved- <br />--- <br />__ r---- .__, ,,,v „.,.,nu r3ante SITU logo are registered Theme of ACORD <br />53309905 1 3e master GL MTD EXCESS ?i0P/ WC I Cladys Silva 112/30/2919 5:39:42 PP, [PST) 1 page 1 of 6 <br />