|
Dlgltallyslgned by Frarnme R.
<br />Francine R, Villareal vlilareei
<br />Date: 2020.10.0717:08:04 -07 b0'
<br />AC o� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMID 20 DffYYY)
<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 pollcy(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 certificate holder in Ileu of such endorsement s).
<br />PRODUCER
<br />eowermaster &Associates
<br />10805 Holder St
<br />CONTACT
<br />NAME; LlZette OFOZCO
<br />PHONE 714-733-6248 AX No:
<br />E-MAINo,LExfl
<br />ADDRESS: lorozco bowermaster.com
<br />Ste 350
<br />Cypress CA 90630
<br />INSURERS AFFORDING COVERAGE
<br />NAICN
<br />INSURER A: Philadelphia Indemnity Insurance
<br />18058
<br />INSURED ILLUFOU-07
<br />Illumination Foundation
<br />1091 N. Batavia Street
<br />INSURERS: Redwood Fife & CaSUBb/ Insurance
<br />11673
<br />INSURERC: Nonprofits' Insurance Alliance Of California
<br />INSURER D :
<br />Orange CA 92867
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 193244276 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 />HER
<br />TYPE OFINSURANCE
<br />ADDLSUBR
<br />POLICYNUMBER
<br />POLICYEFF
<br />(MMIDDNYWI
<br />POLICY EXP
<br />IMMIDDEYYYY)LIMITS
<br />C
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FvI OCCUR
<br />Y
<br />2020-24712
<br />9/15/2020
<br />9/15/2021
<br />EACH OCCURRENCE
<br />$1,000,000
<br />OAMAGERENTED
<br />PREMISESS(Ea
<br />Eaoccurrence)
<br />$500,000
<br />X
<br />MED EXP(Any one arson)
<br />$20,000
<br />Prof LiabillfV
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />GEN'L
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑ JECT LOC
<br />GENERALAGGREGATE
<br />$3,000,000
<br />PRODUCTS - COMPIOP AGG
<br />$3,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />2020-24712
<br />9/15/2020
<br />W15/2021
<br />COMBINED SINGLE LIMIT
<br />Ea accident)
<br />$1,000,000
<br />BODILY INJURY (Par person)
<br />$
<br />ANYAUTO
<br />IX
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />( BODILY INJURY Per accdent) i
<br />$
<br />XIHIRED
<br />X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTYDAMAGE
<br />Per accitlenl
<br />$
<br />C
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />2020-24712-UMB
<br />9/15/2020
<br />9/1512021
<br />EACH OCCURRENCE
<br />$7,OOQ000
<br />AGGREGATE
<br />$7,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED I 'RETENTION$
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />ILWC107887
<br />1/1/2020
<br />1/1/2021
<br />X STATUTE ERH
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />ANYPROPRIETOWPARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />-
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />A
<br />C
<br />Commercial Cyber Uablllty
<br />Improper Sexual Conduct
<br />PHSD1575498
<br />2020-24712
<br />7911
<br />911512021
<br />9115I2021
<br />A99: $3,000,000/Each
<br />A99$1,000,000/Each
<br />$1,000,000
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS l VEHICLES (ACORD 101, Additional Remark.Schedule, maybe attached if more space is required)
<br />City of Santa Ana, it's officers, employees, agents, and volunteers are Additional Insured with respects to General Liability per attached endorsement form;
<br />Primary and Non -Contributory wording applies per attached endorsement form.
<br />30-day notice of cancellation is provided per policy provisions.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Fir
<br />Santa Ana CA 92702
<br />USA
<br />CANCELLATION
<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 />©1988.2015 ACI
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />g,tea n WdrMwlagnnent DirieMl.
<br />m REVIEWED dt APPROVEDBY:
<br />�' f (���,r��� ��g
<br />tr '� Fud,10:1" R. YKr!✓�aAB
<br />" I Risk Managemeri Analyst
<br />
|