LUTHERAN SOCIAL SERVICES OF SOCAL

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Digitally signed by Francine R. Francine R. Villareal Villareal Date: 2021.04.26 14:31:38-07'00' / ACCOR " CERTIFICATE OF LIABILITY INSURANCE FDATE'MM/DD/YYYY) 04114/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 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 certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Elsy Fuentes NAME: Commercial Management Insurance Services Inc. pAH/cNr o (714) 414-1167 (714) 414-1195 (FAX Ext : , No): CA License OD85858 E-MAIL elsy@cmi's-i'ns.com y@ ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 751 S Weir Canyon Rd, 157-355 Anaheim CA 92808 INSURERA: Redwood Fire & Casualty 11673 INSURED INSURER B Lutheran Social Services Of Southern California INSURER C : DBA LSS Community Care INSURER D : 247 E. Amerige Ave. INSURER E : Fullerton CA 92832 INSURER F : COVERAGES CERTIFICATE NUMBER: 2021 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RETED CLAIMS -MADE OCCUR Ea occurrence $ -PREMISES MED EXP (Any one person) $ &ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: -PERSONAL GENERAL AGGREGATE $ POLICY ❑ PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY CEaMBINED SINGLE LIMIT Oaccident $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accide nt) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION ER P` AND EMPLOYERS' LIABI LI TY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A LUWC217692 01/01/2021 01/01/2022 /� STATUTE EORH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EVIDENCE OF INSURANCE COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF SANTAANA ACCORDANCE WITH THE POLICY PROVISIONS. RISK MANAGEMENT DIVISION AUTHORIZED REPRESENTATIVE 20 CIVIC CENTER PLAZA SANTAANA CA 92701ate° ^ F RiskMmRgmerdOiMisiun z REVIEWED & APPROVED BY.- ©1988-2015ACORD fl� ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Risk Management Analyst