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Francine lglallysigned by
<br />Francine R. Villareal
<br />R. Villareal Dale
<br />s 1420200Too,
<br />ACi ci CERTIFICATE OF LIABILITY INSURANCE
<br />DAo (MMID929 DIYYYY)
<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(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 />this certificate does not confer rights to the certtOcate holder In Ileu of such endersemen s .
<br />PRODUCER
<br />CONTAE:CT Nora Wolkoff
<br />NAM_
<br />Dickerson Insurance Services an Mom Group Company
<br />1918 Riverside Drive, Los Angeles, CA 90039
<br />PRONE 323-805-2918 FAX
<br />No
<br />E-MAIL Nora®dlckerson-group.00m
<br />License OOM29112
<br />INSURE S AFFORDWO COVERARE
<br />NgICA
<br />INSURER A: Philadelphia Indemnity Insurance Company
<br />18058
<br />INSURED
<br />INSURERB: Service American Indemnity Company
<br />39152
<br />Charitable Ventures of Orange County
<br />INSURERC:
<br />4041 MacArthur Blvd Ste 510
<br />INSURERD:
<br />Newport Beach, CA 92660-2503
<br />INSURERS.
<br />INSURERF:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 />INBR LIR
<br />TYPEOFINSURANCE
<br />ADD
<br />S
<br />POLICY NUYBER
<br />YYDCY�
<br />YPDUCYEP
<br />LIMITS
<br />COMMERCIAL GENERAL LIABnnY
<br />CLAIMB-MADE ® OCCUR
<br />EACH OCCURRENCE
<br />E 1,000,000
<br />PR MIE Ee
<br />S 100.000
<br />MED EXI ono non
<br />S 5,000
<br />Sexual / Physical Abuse
<br />I
<br />PE1SONAL8AD1INJUR1
<br />E 1,000,000
<br />A
<br />Y
<br />PHPK2137435
<br />07/15/2020
<br />07/1612021
<br />GENLAGGREGATEDMITAPPUESPER:
<br />POLICY 0 JCECTT O LOC
<br />GENEMLAGGREGATE
<br />S 2,000,000
<br />PROWCTS-COMPXIPAGG
<br />S 2.000.000
<br />SI PA AGGREGATE
<br />E 300,00D
<br />OTHER,
<br />AUTOMOBILE
<br />LIMMUTN
<br />COMBINED SINGLELIMIT
<br />Ea acndenl
<br />E i,000,000
<br />BODILYIWURY(Perimm,m)
<br />3
<br />ANY AUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NONOVNED
<br />AUTOS ONLY AUTOS ONLY
<br />Y
<br />PHPK2137435
<br />07/16/2020
<br />07/152021
<br />BODILY IWURY(Per eoddeat)
<br />E
<br />P PERTYDAMAGE
<br />eai
<br />S
<br />S
<br />UYBRELLA UAB
<br />OCCUR
<br />EACHOCCURRENCE
<br />S 4,000,000
<br />A
<br />Excessuge
<br />CLAIM&MADE
<br />Y
<br />PHUS723821
<br />07/1612020
<br />07/152021
<br />AGGREGATE
<br />s 4,000,000
<br />DIED
<br />X1 RETENTONS 10,000
<br />E
<br />B
<br />WORKE<SCOMPENSAMON IN
<br />AND EMPLOYERS' LIABMY
<br />I01Y PROPRIITORPExcwDE��ME YE
<br />OFF(Mentleroryks NH)
<br />Iryaa tlaealae under
<br />DESCRIPTION OF OPERATIONS Wm
<br />NIA
<br />SATIS0326700
<br />07/15RO20
<br />07/15202,
<br />X1 yTp E ER
<br />E.LEACHACCIDENT
<br />E 1,000,000
<br />E.1- DISEASE - EA EMPLOYEE
<br />E 1,000,000
<br />E.1- DISEASE -POLICY UMIT
<br />S 1,000,000
<br />A
<br />Property IF Equipment Coverage
<br />PHPK2137435
<br />07I752020
<br />07I15202t
<br />Limit of Insurance
<br />$127.000
<br />DESCRIPTION OF OPERATIONS MOCATIONS IVEIICLES (ACORD 101. Addleowl Riawks Sche&M, may W eeaehed R mom "am Is re"Ima)
<br />CITY —Its officers, employees, agents, volunteers, and representatives are Included as Additional Insureds with respect to the operations of the named Insured
<br />subject to policy terms and Conditions.
<br />City of Santa Ana
<br />Risk Management Division, 4th Floor
<br />20 Civic Carrier Plaza
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />NORA WOLKOFF
<br />©1988.2015 ACORD COR
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />FRV
<br />,„e.•,.. RIAMmm sgemtD'alalan
<br />Ir ■■``'yr rREVIE &pAP'PIR��o(v�m BY/(:
<br />�. * i `,�• rM1/vMINH[ D, V.cwrAT.
<br />®' Risk Management Analyst
<br />
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