TALLER SAN JOSE HOPE BUILDERS (7)

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Francine R. 1111111yalanm by Fawdre R. Villareal Villareal _r"202tm.z9 1a;1652 Page 1 of 2 CERTIFICATE OF LIABILITY INSURANCE O05/21ATE I/2021Y) 05/21/2021 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 poilcy(les) 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 endorsement(s). PRODUCER Willis (Bermuda) Ltd. Wellesley souse, 2nd Floor 90 Pitts Hay Road CONTACT Willie Towers Watecn Certificate Center NAME: qIC No; 1-888-467-2378 R.E.-877-995-7378 ApD Ecertificates@willis.com INSURERS AFFORDING COVERAGE NAICA Pembroke, MOB END INSURER A: American Unity Group Limited C0929 INSURED Taller San Jose Hope Builders INSURER B: 801 N. Broadway INSURER C: INSURERD: Santa Ana, CA 92701 INSURERE: NSURERF: COVERAGES CERTIFICATE NUMBER: W21008985 RFVISION NIIMRFP- 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 OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADDLSUBR LTft TYPE OF INSURANCE JHM WVD POLICYNUMBER OUCYYFF POLIC EXP LIMITS X COMMERCIALGENERAL LIABILITY EACH OCCURRENCE $ 3,000,000 X CLAIMS -MADE OCCUR DAMAGE TO RE TED PREMISES Ea occunenoe $ MED EXP (Any one erson) $ A y 1-14601-00-21 06/01/2021 06/01/2022 PERSONAL &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 5,000,000 K POLICY PRO- JECT ❑ LOC PRODUCTS - COMP/OP AGO $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea eccldenl $ BODILY INJURY (Par Person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Par accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accldent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER E.L. EACH ACCIDENT $ OF ICERIMEMS REXCLUDED?ANYPROPRIETORIPARTNEWEXECUTIVE ❑ NIA E.L. DISEASE EA EMPLOYEE $ (Mandatory In NH) If year dsacrlba under DESCRIPTION OF OPERATIONS below E, L. DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is requlred) If this Certificate of Insurance is for Professional and / or General Liability insurance this provides evidence of coverage for 1) amployeas while acting within the scope and during the course of their employment with Providence St. Joseph Health and /or 2) contracted parties for their acts, errors or omissions in rendering or failing to render Medical Services outlined by such contract with a Providence St. Joseph Health entity including the Insured identified on this certificate. HOLDER City of Sans. Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE JS_ ©1988.2016 AC ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Sa In: 21126221 BATON: 2103724 r RielrManagznlerdffivislon , $/'(r*IVs� REVIEWED & APtPRCVM BY. E( /19Yll1Yr9adHl.+vF+d Ruk ManageementAnalyst