|
Francine R.
<br />® Villareal
<br />A� b CERTIFICATE OF LIABILITY INSURANCE
<br />Digitally signed by Francine R.
<br />Villareal
<br />DATE(MM/OOIYYYY)
<br />9r13r2021`
<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(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 lieu of such endorsement(s).
<br />PRODUCER
<br />Bowermaster & Associates
<br />10805 Holder St
<br />Ste 350
<br />Cypress CA90630
<br />CONTACT
<br />NAME: LlZelle OfOZCO
<br />PHONE 714-733-6248 acNo:'
<br />E-MAIL
<br />ADDRESS: lorozco@bowermaster.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Philadelphia Indemnity Insurance
<br />18058
<br />INSURED ILLUFOU-01
<br />Illumination Foundation
<br />1091 N. Batavia Street
<br />INSURERS: Redwood Fire & Casualty Insurance
<br />11673
<br />INSURERC: Nonprofits' Insurance Alliance of California
<br />11384
<br />INSURERD:
<br />Orange CA 92867 -
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 622568538 REVISION NUMRFR-
<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 />LTR
<br />TYPE OF
<br />ADDLSUBR
<br />POUCYNUMBER
<br />POLICY EFF
<br />MM/DDIYYVY
<br />POLICY EXP
<br />MMID Y'n
<br />LIMITS
<br />C
<br />X
<br />COMMERCIALGENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />Y
<br />2021-24712
<br />9/15/2021
<br />9/16/2022
<br />EACHOCCURRENCE
<br />$1,000,000
<br />DAMAGERENTED
<br />RENT occurrence)
<br />PREMISESS(Ea
<br />$500,000
<br />X
<br />MED EXP(Anyone person)
<br />$20,000
<br />Prof Liability
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />GEN'L
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY JET LOC
<br />GENERALAGGREGATE
<br />$3,000,000
<br />PRODUCTS-COMP/OPAGG
<br />$3,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />2021-24712
<br />9/15/2021
<br />9/15/2022
<br />COMBINED SINGLE LIMIT
<br />Ea accldenl
<br />$1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Par accldenl)
<br />$
<br />X
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accldenl
<br />$
<br />C
<br />X
<br />UMBRELLA LIAR
<br />OCCUR
<br />2021-24712-UMB
<br />9/15/2021
<br />9115/2022
<br />EACH OCCURRENCE
<br />$7,000,000
<br />N
<br />AGGREGATE
<br />$7,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETOR/PARTNERlEXECUTIVE
<br />OFFICEWMEMBEREXCLUDED9 ❑
<br />NIA
<br />ILWC209336
<br />-
<br />1/11/2021
<br />1/1/2022
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />- -
<br />E.L. DISEASE - POLICY LIMIT
<br />$1.000.000
<br />DESCRIPTION OF OPERATIONS be.
<br />A
<br />C
<br />Commercial Cyber Liability
<br />Improper Sexual Conduct
<br />PHSD1576498.
<br />2021-24712
<br />9/15/2021
<br />9/15/2021
<br />9/15/2022
<br />9/15/2022
<br />Agg:$3,000,000/Each
<br />Agg:$1,000,000/Each
<br />$1,000,000
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re Location: 3535 W. Commonwealth Ave, Fullerton CA
<br />City of Santa Ana, It's officers, employees, agents, and volunteers are Additional Insured with respects to General Liability per attached endorsement form;
<br />Primary and Non -Contributory wording applies per attached endorsement form.
<br />30-day notice of cancellation is provided per policy provisions.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor AUTHORI ED REPRESENTATIVE
<br />Santa Ana CA 92701 IthkMallsgeiderADIAs[on
<br />... 7411
<br />REVIEWED&APPROVED BY,1988-2015 ACORD CACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORDRisk Management Analyst
<br />
|