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Digitally signed by Francine R.
<br />Francine R. Villareal Villareal
<br />_— ,
<br />Dace: 2021.06.040995:22-07-og
<br />®
<br />A� CERTIFICATE OF LIABILITY INSURANCE
<br />DAT6/4120DNWY)
<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 INSURERS), 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 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 />Arthur J. Gallagher & CO.
<br />Insurance Brokers of CA., Inc.
<br />505 N Brand Blvd, Suite 600
<br />Glendale CA 91203
<br />CONYXNAME: C Annie Lee
<br />PHONE . 818.539.8601 aIc No:618,539,8701
<br />IAIC,E-MAIL
<br />ADDRESS: Annie Lee0aig.com
<br />INSURER 3 AFFORDING COVERAGE
<br />NAIC N
<br />INSURER A: Great American Alliance Insurance Company
<br />26832
<br />Icenseri: 0726293
<br />INSURED CRANCOU-19
<br />Orange County Conservation Corps
<br />1853 N. Raymond Ave.
<br />INSURER B : Great American Insurance Company of NY
<br />22136
<br />INSURERC:
<br />INSURER D :
<br />Anaheim, CA 92801
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 1638849878 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 />ILTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />am
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMID MWI
<br />LIMITS
<br />A
<br />X
<br />I COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 1XI OCCUR
<br />Y
<br />PAC 515468016
<br />10/1/2020
<br />10/l/2021
<br />EACH OCCURRENCE
<br />$1,000,000
<br />DAMAGE TO RENT D
<br />PREMISES Ea occurrence
<br />$100,000
<br />MED EXP(My one person)
<br />$5,000
<br />PERSONAL &ADV INJURY
<br />$1,O00000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />%( POLICY [:]JECTPRO- ❑ LOG
<br />GENERALAGGREGATE
<br />$3,000,000
<br />PRODUCTS-COMPIOP AGG
<br />$3,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILELIABILITY
<br />CAP 099124907
<br />10/1/2020
<br />10/1/2021
<br />COMBINED SINGLE -LIMIT
<br />Ea accident
<br />$1,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Par
<br />(e )
<br />$
<br />X
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Par accident
<br />$
<br />Cem &Collision
<br />$50D1$500
<br />A
<br />X
<br />UMBRELLA LIAR
<br />Xd
<br />OCCUR
<br />UMB 560379516
<br />10/1/2020
<br />10/1/2021
<br />EACH OCCURRENCE
<br />$4,000,000
<br />AGGREGATE
<br />$4,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED X RETENTION$ in one
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETORIPARTNEWEXECUTIVE
<br />OFFICERIMEMBEREXCLUDEDY
<br />NIA
<br />I PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$
<br />E.L. DISEASE - PA EMPLOYEE
<br />$
<br />(Mandatory, in NH)
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT
<br />$
<br />DESCRIPTION OF OPERATIONS has..
<br />A
<br />Abuse and molestation
<br />PAC 515468016
<br />10/1/2020
<br />10/l/2021
<br />Per Claim
<br />$1,000,000
<br />Aggregate
<br />$3,000,000
<br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Policy: Professional Liability
<br />Policy #: PPAC 5154680 16
<br />Carrier:Great American Alliance Insurance Company
<br />Policy Term: 10101/2020-10/0112021
<br />Per Claim: $1,000,000 /Aggregate: $3,000,000
<br />RE: Agreement Number: A-2020-142 I Project: Adult and Dislocated Worker Training I
<br />The City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as named additional insured with respect to the operations of
<br />See Attached...
<br />City of Santa Ana
<br />Risk Management Division,
<br />20 Civic Center Plaza, 4th floor
<br />Santa Ana CA 92701
<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 />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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<br />REVIEWED&APPROVEJBY:
<br />I , P. V•
<br />RiaA Management AnalyTt
<br />
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