ORANGE COUNTY CONSERVATION CORPS (5)

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A o� CERTIFICATE OF LIABILITY INSURANCE DAM IMMI2020Y() THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such entlorsement(s). PRODUCER Arthur J. Gallagher & Co. Insurance Brokers of California, Inc. LIC# 0726293 1255 Battery Street #450 San Francisco CA 94111 CONTACT PHONE FAX c a ac Na: ADDRESS: INSUREMS AFFORDING COVERAGE NAIC# INSURERA: NonProfts' United Workers' Com ensation Group INSURED NONPUNI-01 Orange County Conservation Corps 1853 North Raymond Avenue INSURERS: SafetyNational CasualtyCorporation 15105 INSURERC: Response IndernMy Company of California 10970 INSURER D : Anaheim, CA 92801 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1153230747 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AOOL SUBR POLICYNUMBER POLICY EFF MMIDD/YYYY POLICY UP MM/DDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY E71OCCUR EACH OCCURRENCE $ DA N ED CLAIMS -MADE PREMISES Ea commerce) $ MED EXP (Any one person) $ PERSONAL B ADV INJURY $ GENT AGGREGATE U MIT APPLIES PER: POLICY E PRO- ECT ❑ LOC GENERALAGGREGATE $ PRODUCTS-COMP/OPAGG $ $ OTHER: AUTOMOBILELIBWTY COMBINED SINGLE LIMIT Ea assistant $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS (Per accident) BODILY INJURY (P$ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Falsest ent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DEAD RETENTION$ $ A WORKERS ANDEMPLOYERS-LIABI,ON LIITY YIN NPU-WCG 001-2021 V7/2021 1/1/2022 X STATUTE OERH- E.L. EACH ACCIDENT $500,000 ANYPROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED4 NIA E.L. DISEASE - EA EMPLOYEE $500,000 (Mandatary in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $500.000 DESCRIPTION OF OPERATIONS helm C B XSWC - Buffer Layer XSWC ABL1000013-00 SP4064079 1/1/2021 1/1/2021 1/1/2022 1/1/2022 XS of$50g000 XS of$75g000 XS of $75g000 $250,000(EL B WC) $2,000,000(EL) Statutory (WC) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached U more space is required) City of Santa Ana 20 Civic Center Plaza 4th Floor Santa Ana CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE ©1988-2015 ACORD C ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD _ e Risk ManagealterdDilvion i�rYv^iN k% REVIEWp SppAPtPIRO�V�ED By. FU4.&n �r r'. V�i,ci✓trA.c `® Risk Management Analyst 01