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<br />A� CERTIFICATE OF LIABILITY INSURANCE
<br />CAM(MM/DD/YYYY)
<br />07/30/2020
<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 WANED, 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 each endorsements .
<br />PRODUCER
<br />Dickerson Insurance Services an Alera Group Company
<br />1918 Riverside Drive, Los Angeles, CA 90039
<br />License #OM29112
<br />CONTACT Nora Wolkoff
<br />NAME
<br />PNDNE 12,00. 323-805-2918 FAc No:
<br />E,mAIL . Nora@dlckerson-group,com
<br />INSURE S AFFORDINOCCVERAGE
<br />MAC p
<br />INSURERA: Philadelphia Indemnity Insurance Company
<br />18058
<br />INSURED
<br />Charitable Ventures of Orange County
<br />4041 MacArthur Blvd Ste 510
<br />Newport Beach, CA 92660-2503
<br />INSURER e: Service American Indemnity Company
<br />39152
<br />INSURER c :
<br />INSURERD:
<br />INSURER E
<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 />IN50. LTRTYPE
<br />OF INSURANCE
<br />ADDL
<br />SueR
<br />POLICY NUMBER
<br />NNuDE�
<br />LINILID��
<br />UNITS
<br />XJ
<br />COMMERCNLGENERALLU1amITY
<br />EACH OCCURRENCE
<br />S 1.000,000
<br />CIAIM"AOE ® OCCUR
<br />PREMISES Ee 000 Trance
<br />S 100,OOD
<br />MED EY.P An one anon
<br />$ 5,000
<br />Sewlal/Physical Abuse
<br />PERSONAL S ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />PHPK2137436
<br />07/15/2020
<br />07/15/2021
<br />DEVIL AGGREGATE UMr APPLIES PER:
<br />GENERALAGGREGATE
<br />S 2,000,000
<br />POLICY ❑ JECT O LOC
<br />PRODUCTS-COMPIOPAGG
<br />S 2,000,000
<br />OTHER:
<br />S I PA AGGREGATE
<br />s 300.000
<br />AUTOMOBILE LIABILITY
<br />COMBINEDSINGLELIMIT
<br />Eaacadent
<br />S 1,000,000
<br />BODILY INJURY (Per person)
<br />S
<br />ANY AUTO
<br />A
<br />AOWr AI)TO SCCHHEEDDULED
<br />HIRED NON-0wPIED
<br />AUTOS ONLY AUTOS ONLY
<br />Y
<br />PHPK2137435
<br />07/152020
<br />07/15/2021
<br />BODILY INJURY (Per aetidem)
<br />s
<br />PROPERTY DAMAGE
<br />Per aoddem
<br />S
<br />S
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />s 4,000,000
<br />A
<br />EKCESa UAB
<br />CIAIMSM4DE
<br />Y
<br />PHUB723821
<br />07/152020
<br />07/152021
<br />OEO
<br />RETENTIONS 10,000
<br />S
<br />B
<br />WORKERS COMPENSATION
<br />TY
<br />AND EMPLOYERS UABIUY
<br />ANYPROPRIEe RIPART EIVE EVE �
<br />OFFICERIMEM(Mandatory In NH)
<br />NIA
<br />SATIS0326700
<br />07/152020
<br />07/15202.1
<br />STATUTE ER
<br />E.L EACH ACCIDENT
<br />a 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />S 1,000,000
<br />Ir ))es, daeai0e un0er
<br />DESCRIPTION OFOPERATIONS W.
<br />E.L. DISEASE - POLICY UNIT
<br />S 1,000,000
<br />q
<br />Property / Equipment Coverage
<br />PHPK2137435
<br />07I152020
<br />071152021
<br />Limit of Insurance
<br />$127,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remade Schedule, may be adeemal R more space Is required)
<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 C6vic Center Plan
<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 />AUTHORIZED REPRESENTATIVE
<br />NORA WOLKOFF
<br />[off.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />RidrManagement Division
<br />v�'93 RREmejvED&pAPPROVE) BY.
<br />' rvWYi�-FZ ram. V�1[�.
<br />�i
<br />® Risk Management Analyst
<br />
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