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Francine R. 9u�inivMawna„m.w. <br />Villareal <br />ACORbr CERTIFICATE OF LIABILITY INSURANCE <br />II <br />DATE(MMIDO YYVV) <br />12/30/2020 <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(les) 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 lieu of such endorsement(s). <br />PRODUCER BOitOn B Company <br />3475 E. Foothill Blvd., Suite 100 <br />Pasadena, CA 91107 <br />CONTACT <br />NAME: <br />PHONE 626 799-7000 FAXCCC No: 626 583-2117 <br />E-MAIL <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />www.boitonco.com 0008309 <br />INSURERA: The Hanover American Insurance Company <br />36064 <br />INSURED <br />YMCA of Orange County <br />13821 Newport Avenue Suite 200 <br />INSURER B : Cypress Insurance Company <br />10855 <br />INSURER C: <br />INSURER D: <br />Tustin CA 92780 <br />INSURER E; <br />INSURER F : <br />UUVERAL9ES CEH IIHCA I NUMHER' ROAnn'2OR RFVIRIr1M MIIMRr:G- <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 />INSR <br />TYPE OF INSURANCE <br />ADDLSUBR <br />POLICYNUMBER <br />POLICYEFF <br />IMMIDDfYYYYI <br />POLICYEXP <br />MMIDDIYYYY <br />LIMITS <br />A <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE �✓ OCCUR <br />Includes Sexual Abuse Coverage <br />✓ <br />ZZ3D79134002 <br />1/l/2021 <br />1/1/2022 <br />EACH OCCURRENCE <br />$1000000 <br />AMAGETORNTED <br />PREMISES (EaEoccurmnca) <br />$1 000 000 <br />✓ <br />MED EXP (Any one peson) <br />$20,000 <br />PERSONAL &ADV INJURY <br />$1'000 000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑ jEa 171 LOC <br />OTHER: <br />GENERAL AGGREGATE <br />$2,000,000 <br />PRODUCTS - COMPIOPAGG <br />$2 000,000 <br />$ <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />AW3D79131302 <br />1/1/2021 <br />1/1/2022 <br />COMBINEDSINGLE LIMIT <br />$1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY Per accident <br />$ <br />PROPERTY -DAMAGE <br />per accident <br />$ <br />A <br />,/ <br />UMBRELLAUAB <br />EXCESS LIAB <br />CLAIMS -MADE <br />I <br />UH3D79134102 <br />-1/112021 <br />1/1/2022 <br />1 <br />EACH OCCURRENCE <br />$15000000 <br />IOCCUR <br />AGGREGATE <br />$15,000,000 <br />DED RETENTION$ <br />1 <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILIITY YIN <br />ANYPROPRIETOR/PARTNEREXECUTIVE <br />OFFICERIMEMBEREXCLUDED9 <br />(Mandatory In NH) <br />If yes, describe antler <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />YMWC201982 <br />1/1/2021 <br />1/1 /2022 <br />✓ STATUTE EORH <br />E.L. EACH ACCIDENT <br />$1000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$1 OO <br />E.L. DISEASE - POLICY LIMIT <br />$1 000000 <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />GL Additional Insured and Primary & Non -Contributory Wording apply per 42129150615 attached, only if required by Written contractiagreement. <br />GL Cancellation Clause applies per IL00171198 attached. <br />Re: Operations of the Named Insured. Additional Insured(s): City of Santa Ana. <br />,tlq ANI;I WINI:I <br />Git of Santa Ana <br />y <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Risk Management Division <br />THE EXPIRATION DATE THEREOF, <br />NOTICE WILL <br />BE DELIVERED IN <br />20 Civic Center Plaza <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />a.=yy <br />R1nkMan�vrnvmtDitisfon <br />Debra R09a9 <br />s� <br />REVIEWED& APPROVED BY. <br />©1988-2015 ACORD C <br />9� ,,� <br />(�• <br />ACORD 25 (2016103) <br />The ACORD name and logo are registered marks of ACORD <br />Risk. Management Analyse <br />59400308 12021 Hooter GL AUTO 6XC PROF/ WC An9e1 Simenez 112/3C/2020 11:14:40 AN (PST) I Page 1 of 6 <br />_ <br />