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Francine R. Vf11�PA�FXH�Pti ,,2-byrrmaneR <br />IM r.10 l.uamu` 3�22 -0)'n0 <br />DATE(MMIODYVYVI <br />6/4/2021 <br />�-� CERTIFICATE OF LIABILITY INSURANCE <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 provision$ 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 lieu of such endorsements . <br />PRODUCER <br />Arthur J. Gallagher 8, Co- <br />Insurance Brokers of CA., Inc. <br />505 N Brand Blvd, Suite 600 <br />CONT TcT <br />NI Annie LeePHON-� FA ' .818.539.8701 <br />818.530.8601Nn1. <br />- ` Annie Lee@atg.com.._, <br />Glendale CA 91203 <br />_ <br />INSURERISI AFFORDiNO COVERAGE NAIC9 <br />INSURER$: Great American Alliance Insurance Com an <br />26832 <br />Ptcensej(;_n7,?,UZ <br />INSURED CRANCDU,19 <br />Orange County Conservation Corps <br />1653 N. Rayrnond Ave. <br />INSURER8: Great American Insurance Company Of NY <br />22136 <br />- --- <br />INSURER O <br />Anaheim, CA 92801 <br />INSURERD: <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 1638849878 REVISION NUMBER: <br />TI [IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE; LISTED BELOW I IAVE BEEN ISSJED TO THE INSURED NAMED ABOVE. FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIT, RESPECT 10 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 />IL ER TVPE aFINIURANCF. A P LICY NUMBER MM POLICYp �` ����pp <br />O UDYEW M�bY YW11 LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />Y <br />PAC 515468016 <br />1D/112020 <br />10/1/2021 <br />EAC-ICCCJRRENee. <br />$1,000i000 <br />(C A -MARE occuR IM9 <br />PREMISC-S (C 66 _nnn <br />3100000 _ <br />ME[) EXP (Any ono oerson) <br />$ 5.000 <br />PERSONA AAI)V INJI,IftY <br />$1,000,000 <br />_ <br />GFNI AOOHFOAIF LIMIT APPLIES PER <br />GENFRALAGGREGATC <br />$3,000000 <br />X POLICY L ECT LOC <br />PRODJCTS-COMPIOPAGG <br />$3.000.000 <br />S <br />OTHE. <br />a <br />AUTOMODILELJABIL <br />TY <br />CAP 0991249 07 <br />10/1/2020 <br />10/1/2021 <br />n nr-N-9 IN da�T L L. MI <br />$1.000.000 <br />HO]ILV IN.URY(Perporoo <br />X <br />ANYAUI"O <br />OWNED <br />AUTOS ONLY _...... ALT(11 <br />BODILY INJJRY (Par-., oltlnnq <br />$ <br />X <br />HIRED <br />AUT03 ONLY X- ALIOS ONLY <br />PftOPEN77PSAMAO <br />LROPE iOAntt .- . <br />$ - <br />._. <br />Com A Coll elan <br />$ 500 3500 <br />A <br />X <br />UMBRELLA LIAB <br />X <br />OCCJR <br />._...... .........................._. <br />JMB 5a03]051a <br />10/1/2020 <br />10I112021 <br />.......000. <br />EACH OCCURRENCE <br />$4.000,000 <br />AOGREGase <br />$4000.000 <br />EXCESS LIAR <br />CLAIMS -MADE <br />0£1 XHETENTION$ <br />_ <br />WORKERS COMPENSATIONPLIR <br />r.- <br />...g.. <br />ANDEMPLOYERS LIAa14ITYYIN <br />A�JTE� <br />ANY10FR(M MBFR XCL_DLE%ECu'rNa <br />OFHCFR/MFIIINN) CLUDEDI <br />NIA <br />FL EACH ACOIOENT <br />— — <br />8 _ <br />(MenLlatory In NH) <br />61_ n:yFA9E-F:A EMPLOYEE <br />_.EASC- <br />$ <br />u yyaS (PTIDN tinder <br />DCSLIRIPTIONpFOFFRgrl9NanalDw <br />CL DISC-ASE-POLICY LIMIT <br />---'-- <br />3 <br />A <br />ADLSGNIUm010WSIlOn <br />PAC G15469016 <br />10/1/2020 <br />10P12021 <br />PerCleim <br />$1000,000 <br />A99009Ste <br />$3,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Romarko Sahoduio, maV fie oot.,nII it moo spaco is ro9uirad) <br />Policy: Professional Liablllty <br />Policy If. PPAG 5154680 16 <br />Carrier :Great American Alliance Insurance Company <br />Policy Perin. 10/01/2020-1010112021 <br />Par Claim: $1,000,000 l Aggregate: $3,000,000 <br />RE: Agreemoni Numbor: A-2020-142 I Pro)ect. Adult and Dislocated Worker Training <br />T'he City or Santa Ana, its officers, employees, agents. volunteers and roprasanfatives are named as named additional insured with respect to the, operations of <br />See Attached... <br />CERTIFICATE <br />City of Santa Ana <br />Risk Management Division, <br />20 Civic Center Plaza, 4th floor <br />Santa Ana CA 92701 <br />ACORD 25 (2016/03, <br />SHOULD ANY OF TI1E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE.. WII_I_ BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTIIIORIZEED�`REI <br />K�'1rtp(}.Yy <br />liII IF::I:f;W411ily_VIAICI91[of <br />The ACORD name and logo are registered marks of ACORD <br />f r ldak idAnpgrmeal DlNSlon <br />{{�RCe1emEO in AF hWEO BV: <br />111 <br />momHUB M, nnywucnp HnzlylL <br />