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Francine Digitally signed by nAaioclnn9i VlllaArealpage 1 of 2 rC. VilldlCdl 08:30:55-07' AC40R CERTIFICATE OF LIABILITY INSURANCE 0' AT DE(MM/DD/YYYY) 09/29/2021 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 policy(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 - Willie Towers Watson Insurance 8ervioae Weat, Inc. a/o 26 Century Blvd P.O. Box 305191 CNOAM T Willis Towers Watson Certificate Center NME; PHONE 1-877-945-7378 FAX 1-B88-467-2378 C , A/C No: ADDRESS: certificatespwillia.com INSURERS AFFORDING COVERAGE NAIC# Nashville, TN 372305191 USA INSURER A; Weatahoster Surplus Lines Insurance ComQan 10172 INSURED The Salvation Army - Division 17 30840 Hawthorne Blvd., HIS, D INSURER B: Greenwich Insurance Company 22322. INSURERC: EL Specialty Insurance Company 37885 INSURER D: Hanaho Pelee Verde., CA 90275 INSURER E: INSURER F : COVERAGES - CERTIFICATE NUMBER: W22306682 REVISION NUMBER: 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 OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ICY LTR LTR OF INSURANCE ADOLTYPE INSD3 VP_ POLICYNUMBER MM/ODY�Y EXP MMI�DMYYY LIMITS- X COMMERCIAL GENERAL LIABILITY ENCE $ 2,000,000 CLAIMS -MADE OCCUR DAMAGE TO occurence $ 1,000,000 X one Person) $ 0 A Self Insured Retention: X $1,000,000 y G7183119A 002 10/Ol/2021 10/Ol/2022DV INJURV rGENER�AL $ 2,000,000 LIMITAPPLIES PER: REGATE $ 4,000,000 GENIAGGREGATE POLICY PRO LOU OMNOP AGO $ 4,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Par person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Par accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ H AGGREGATE $ EXCESS LIAR CLAIMS MADE DEO I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANVPROPRIETORIPARTNE WEXECUTIVE PER STATUTE ER E.L. EACH ACCIDENT $ OFFICERWEMBEREXCLUDED4 ❑ N/A (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ If yes, describe under O ESCRI PTION OF OPERATIONS below B Excess Auto Liability - CA y RAE500021811 10/Ol/2021 10/OL/2022 Any Auto / CSL $3,000,000 Self-Insd Retention $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Location Code: 17-145-10-01-01 - Santa Ana Hospitality House Shelter CA -Business Auto is fully Self -Insured per the attached State Certificate. SEE ATTACHED CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana Risk Management Division AUTHORIZED REPRESENTATIVE 20 Civic Center Plasa kyen+y RiskMmagenodDlublon Santa Ana, CA 92702 � 1 �. REVIEWED&APPROVEDBY: ©1988-2016 ACORD C Maki" F401i P, V - ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD '�'I Risk Management Analyst SR ID: 21630631 Brace: 2252947 .. .__.