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Francine R. blgitally,]," dby <br />Francine K Villareal <br />Villareal Date: 2021.07.0511:11:09 <br />-07-00' <br />r CERTIFICATE OF LIABILITY INSURANCE <br />DATS(MMmoArm) <br />U EV2021 <br />TH13 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO MONTS 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 ACONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE' CERTIFICATE HOLDER <br />IMPORTANT: Ittho carttficate holder Is an AUDITIONAL INSURED, the policy(fes) must have ADDITIONALINSURED provisions orbe andorsed. <br />It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, cortatn poliedae may require an endorsement. A statement on <br />this certificate does not senior rights to the certificate holder In Batt of Such ondomement(s). <br />PRODUCER <br />NAMS:C Certificate. Iast/anco Team <br />Comprehensive lnsumncs Services <br />No E (gAg) 709 8500 049) 70&1860 <br />� <br />26429 Rancho Parkway $OUin <br />..AUaN°.te.... ..................� <br />ADDRESe:)e2mY@InaCOnrprehenSlVClneUfanm.CUm <br />SORB 120 <br />tNSORER(SI APFORWNOOOVERAGE <br />NAICR <br />Lak2 Forest CA 92630 <br />INSURERa: Nonprofits InsOmnceAlllance of California <br />10023 <br />INSURED <br />INSURER B: State Compensation Insurance Fund <br />35076 <br />Orange County Fair Housing <br />INSUREPe t <br />2021 E. Ath St. Ste. 118 S 122 <br />wsURERO; <br />INSURERS! <br />.__............._......................._.........-................_..,....�...,....:......-.._.. <br />SsmaAna CA 02745 <br />tusuaeRF; <br />........m.._ <br />NUMBER! CL2 <br />THIS IS TO CERTIFY THATTHE.POLICIES OF INSURANCE USTEO BELOW HAVE BEEN ISSUEDTO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENVAITHRESPECTTO WHICH THIS <br />CERT)FIGATEMAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POUCIESDESCRIBED HEREIN IS SUSJECTTOALt.TETERMS, <br />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED 9YPAIO CLAIMS. <br />i <br />lft <br />TYPE OF INSURANCE <br />INSO <br />POUCYNUMaER <br />POUCYEFF <br />MIAMONYYY <br />POUCY <br />m"D <br />LIMBS <br />COMMERGALOERERALUXDIUTY - I.. <br />� <br />CLAIM"A➢e OCCUR <br />EACH gGCURREN(:E.. <br />S 1,000,000 <br />PREMISES <br />S 600,000 <br />MEDEXP An nna reon <br />$ 20,000 <br />A <br />Y <br />2021. tf?33 <br />071OV2021 <br />0710112022 <br />eM% A1.&AOVIWURY. <br />s 1,000OD0 <br />GENLAGOREGATE <br />LIMITAPPDES PER: <br />POLICY C ®tAG <br />GENERALAGCREGATE <br />$ 3,ODO,OOO <br />gRODUOTS-COMplOpAGO <br />a 3,000,000 <br />$ <br />OTHER. <br />AUTOM001IXUAWLITY <br />COMBINED NCLEL IT <br />Ea a<ddent <br />g 1,000.000 <br />nODILYINJORY (Perpmm). <br />$ <br />ANYAUTO <br />A <br />1 + <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED x NON-0WNM <br />AUTOS ONLY AUTOS ONLY <br />2021.03733 <br />0710MO21 <br />07101/2022 <br />000IYINANOWeraccidenn <br />S <br />QP TY AMA.. ' <br />accW ren <br />$ <br />, <br />S <br />UMOSRLLAUAM <br />X <br />OCCUR <br />v <br />EAGH OCC. ILRENCE <br />$ 1,000,000 <br />A <br />EXCESS UAB <br />CLAIMS <br />2021-03733,UMB <br />07/0112021 <br />07101/2022 <br />NOOnEUATE <br />$ 1,000.000 <br />DED RETENTON s <br />It <br />B <br />WORKERSCOMPENSATION <br />ANDEMPLOY Tor LIABILITY IN <br />ANY PROPRIETORMARTNEWM- CUTIVE YJ'hl'j <br />OFFICERIMEMBER EXCLUDED? <br />(Mondatoryin NH) <br />IFyes, describe Vn a <br />DESCRIPTION bF OPERA110NSUslrrx <br />N/A <br />E09g740^11 <br />O$(15f2O21. <br />05/16/2022 <br />AAff OTN• <br />[PER <br />l`� <br />"___....� _ <br />EL-rACHACCIDENT <br />S 1,000,000 <br />E.L. DISEASE- FAEMPLOYEE <br />$ 1,D00,000 <br />EL DISEASE -POLICY LIMITS <br />110001000 <br />A <br />Improper Sexual Conduct UaWlity <br />202"3733 <br />07101t2021 <br />07/01/2022 <br />51,00DOODAggregato <br />$1,000,00 Ocxt mmoo <br />DFSGmPTl4N 4F OFERAnON3lLOCATIgNStYSNICLae tAGORO)at; AtitllOonal RnmarasSW»dvle; may Aa AltanhednmbYBapaneb renul.edl <br />The City of Santa Ana, its officers, employees, agents, volunteers and roprasentati"s are included asAddhionai Insured per attached endorsement NIAC <br />Etif. This insurance is Primary and Non-centribWory per endorsement NUAC E61. 30 day notice of cancellation with 10 day notice of cancellation for <br />non-payment of premium M policy provision. <br />SHOULD ANY OF THEA13OVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILLI3E DELIVERED IN <br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS, <br />Risk Management Divison—o....- <br />20 Civic Center Place AUTHORED REPRESF.NTATwE <br />Santa Ana CA 92701 <br />liinkManygelnerd Division <br />Ei 1588.2016 ACORDC - REVIEY7ED&APPROVED BY.. <br />ACORD 28 (2016103) The ACORD name,and toga are registered marks of ACORD F04044 P, V*" <br />Rick Management: Analyst <br />