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Francine R.
<br />® Villareal
<br />A� ® CERTIFICATE OF LIABILITY INSURANCE
<br />Dlgltallyslgned by Francine R.
<br />Villareal
<br />1 DATE IMM/DDIYYYY)
<br />9/13/2021
<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 />CONTACT
<br />Liz Orozoo
<br />PHONE
<br />714ette 733-62 FAX
<br />714-733-6248 ac No),
<br />nooaess, lorozco bowermaster,com
<br />Cypress CA 90630
<br />INSURERS AFFORDING COVERAGE
<br />NAIC 9
<br />INSURERA: Philadelphia Indemnity Insurance
<br />18058
<br />INSURED ILLUFOU41
<br />Illumination Foundation
<br />1091 N. Batavia Street
<br />INSURERB: Redwood Fire & CasualtyInsurance
<br />11673
<br />INSURERC: Nonprofits' Insurance Alliance of California
<br />11384
<br />INSURER D:
<br />Orange CA 92867
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 622568538 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADEL
<br />SUER
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDIYYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />C
<br />X
<br />COMMERCIALGENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />V
<br />2021-24712
<br />9/15/2021
<br />9/16/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />0 ET RENTED
<br />PREMISES Ea occurrence)
<br />$500,000
<br />X
<br />MED EXP (Any one 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 ❑JE� LOC
<br />GENERALAGGREGATE
<br />$3,000,000
<br />PRODUCTS - COMPIOP AGO
<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 accident
<br />$1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED 6CHEOULEO
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />(
<br />$
<br />X
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTYDAMAGEAGE
<br />Per accitlent
<br />$
<br />C
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />2021-24712-UMB
<br />9/15/2021
<br />9/15/2022
<br />EACH OCCURRENCE
<br />$7,000,000
<br />AGGREGATE
<br />$7,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />CEORETENTION$
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ILWC209336
<br />1/1/2021
<br />1/1/2022
<br />X STATUTE 10
<br />ERH
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />ANYPROPRIETORIPARTNEWEXECUTIVE ❑
<br />OFFICERIMEMBER EXCLU DED?
<br />NIA
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />Ir yes,descrlbe under
<br />-
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />C
<br />Commercial Cyber Liability
<br />Improper Sexual Conduct
<br />PHSD1675498
<br />2021-24712
<br />9/15/2021
<br />9/15/2021
<br />9/15@022
<br />9/15/2022
<br />Agg:$3,000,0001Each
<br />Ag9'$1,000,0001Each
<br />$1,000,000
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may he 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 />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana CA 92701
<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 />9)1988-2015 ACORD Ci
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />Risk Mana%emnit Division
<br />REVIEWED&APPROVED BY:
<br />RIA Management Analyst
<br />
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