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Francine R.
<br />Villareal
<br />AIDSSER-01
<br />Digitally signed by Francine R.
<br />Villareal
<br />Date: 2021.05.03 15:04:08-07'00'
<br />SJOHNSON
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />LATE /41202YYYY)
<br />'� I412021
<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 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 License # 0827761
<br />CalNonprofits Insurance Services
<br />PO Box 640
<br />Capitola, CA 95010
<br />CONTACT Sandra Johnson
<br />NAME:
<br />PHONE FAX
<br />(Arc, No, EA): (888) 427-5224 3034 (AIC, No):(831) 824-5049
<br />a oRIL Sandra@cal-insurance.org
<br />INSURER 5 AFFORDING COVERAGE
<br />NAIL#
<br />INSURER A : Nonprofits Insurance Alliance of California
<br />10023
<br />INSURED
<br />INSURER B : Service American Indemnity Company
<br />39152
<br />AIDS Services Foundation Of Orange County dba Radiant
<br />Health Centers
<br />INSURER C
<br />17982 Sky Park Circle, Ste. J
<br />INSURER D :
<br />INSURER E :
<br />Irvine, CA 92614
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR-
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO 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 />INSR
<br />TYPE OF INSURANCE
<br />ADDL
<br />i D
<br />SUBR
<br />wVO
<br />POLICY NUMBER
<br />POLICY EFF
<br />MOD=
<br />POLICY EX?
<br />MMIDDTYYYYi
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />2020-08363
<br />712912020
<br />W2912021
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PftEMISESOERENTED n
<br />$ 5001000
<br />MED EXP (Any one arson
<br />$ 20,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENT
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY IA JEO ❑ LOC
<br />GENERAL AGGREGATE
<br />$ 3,000'000
<br />PRGOUCTS - 00 PLOP AGG
<br />$ 3,000,040
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />X
<br />BODILY INJURY Perperson)$
<br />_
<br />ANY AUTO
<br />2020-08363
<br />712912020
<br />7/2912021
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON-OWNEO
<br />AUTOS ONLY AUTOS ONLY
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />AGGREGATE
<br />$ 4000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />2020-08363-UMB
<br />7/2912020
<br />7129/2021
<br />DED X RETENTION $ 10,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y 1 N
<br />ANY PROPRIETORIPARTNERIEXECUTIVE �
<br />(Mandatory in NH) OFFICERJMMBER EXCLUDED?
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N 1 A
<br />SATIS0394900
<br />11112021
<br />1/112022
<br />X PER OTH-
<br />TAT 7E ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />1,000,000
<br />$
<br />E.L. DISEASE- POLICY LIMIT
<br />1,000,000
<br />A
<br />Professional Liab
<br />2020-08363
<br />712912020
<br />712912021
<br />$1 M1Event-Aggregate
<br />3,000,000
<br />A
<br />Abuse & Molestation
<br />2020-08363
<br />7/29/2020
<br />712912021
<br />Ea. Claim/Aggregate
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS f LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ana, officers, agents, employees, and volunteers are named as Additional Insured with respect to Generat Liability as required by
<br />written contract per forms attached.Coverage is Primary & Non-contributory and Blanket Waiver of Subrogation applies. Certificate of Insurance shall
<br />provide thirty (30) day prior written notice of cancellation
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />Y
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL
<br />BE DELIVERED IN
<br />Risk Management Division
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />/ `J
<br />oRaN
<br />�-
<br />IiAMwagmentDivisian
<br />F
<br />} %
<br />REVIEWED &APPROVED BY.-
<br />ACORD 25 (2016/03)
<br />001988-2015 ACORD CO
<br />z
<br />The ACORD name and logo are registered marks of ACORD
<br />MM
<br />��
<br />Risk Management Analyst
<br />
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