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COUNTY OF ORANGE <br />v s CERTIFICATE OF SELF-INSURANCE <br />Office of Risk Management, 601 N. Ross Street, 5th Floor, Santa Ana, CA 92701 <br />Covera2c: This is to certify that the County of Orange is self -insured for the following <br />coverage: <br />Type of Coverage <br />Self -Insurance Limit <br />General Liability: Bodily Injury and Property Damage <br />$1,000,000 per occurrence <br />$2,000,000 per aggregate <br />Automobile Liability - Vehicles owned, non -owned, and hired <br />$1,000,000 per occurence <br />Workers' Compensation - $20,000,000 SIR applies <br />Employers' Liability <br />Statutory <br />$1,000,000 per occurrence <br />Terms. Conditions and Special Items: <br />The provisions under General Liability, above, shall apply only with respect to claims arising out of the <br />negligent acts or omissions of the County of Orange, its officers, agents and employees. <br />Cancellation: <br />Should any of the above described self -insured coverage be modified or cancelled before the <br />expiration date shown below, the County of Orange will provide 30 days written notice to the named <br />certificate holder. <br />Indemnified Party: <br />City of Santa Ana, its officers, employees, agents, volunteers and representatives pursuant to the terms <br />of the Vote Center Entry Permit. <br />Certificate Holder <br />City of Santa Ana <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana, CA 92701 <br />ATTN: Risk Management Division <br />LOCATION 706 N. Newhope St., Santa Ana, CA <br />RE: Ballot Drop Box - Salgado Recreation Center, <br />Gym <br />DATE: October 23, 2020 - November 10, 2020 <br />Effective Date: 10/23/20 <br />Expiration Date: 11/10/20 <br />Rhonda Marshall ":.::�. ""''^°'^•-°:": <br />Risk Management <br />4) 285-5500 <br />to Certificate <br />iuu mwugemet¢ �txe�on <br />Oz+ REv e&M S APPRO SY: <br />FnRn c e l'. $fFneaf <br />�� R¢k Management Analyst <br />