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Francine Ggllel"sN"'by <br />Fraadae R. Villa I <br />Dale zo31.102 age 1 of 2 <br />R. Villareal ��_:_. <br />A� o> CERTIFICATE OF LIABILITY INSURANCE <br />ATE (NEI <br />D09/29/2021 <br />09/29/2021 <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 />Willis Towers Watson Insurance Services West, Inc. <br />c/o 26 Century Blvd <br />P.O. Box 305191 <br />CONTACT Willis Towers Watson Certificate Center <br />NAME: <br />PHONE <br />aC No: 1-888-467-2378 <br />ce1-877-945-7378 <br />E-MAIL xti£icates@williS.com <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE <br />NAICY <br />Nashville, IN 372305191 USA <br />INSURER A: Westchester Surplus Lines Insurance Compan <br />10172 <br />INSURED <br />The Salvation Army - Division 17 <br />30840 Hawthorne Blvd., Bldg D <br />INSURER B: Greenwich Insurance Company <br />22322 <br />INSURERC: EL Specialty Insurance Company <br />37885 <br />INSURERD: <br />Rancho Palos Verdes, CA 90275 <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: W22306682 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 />ADDLSUBR <br />POLICY NUMBER <br />POLICY EFF <br />MMIDD <br />POLICY EXP <br />MIMIDDJYYYY1 <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 2,000,000 <br />CLAIMS -MADE OCCUR <br />DAMAGE TO RENTED <br />PREMISES Ea owunence <br />$ 1,000,000 <br />X <br />MED EXP(Any one person) <br />$ 0 <br />A <br />Self Insured Retention: <br />X <br />$1,000,000 <br />y <br />G7183119A 002 <br />10/01/2021 <br />10/01/2022 <br />PERSONAL &ADV INJURY <br />$ 2,000,000 <br />AGGREGATE LIMIT APPLI ES PER: <br />GENERALAGGREGATE <br />$ 4,000,000 <br />GEN'L <br />POLICY JE� X LOC <br />PRODUCTS-COMPIOPAGG$ <br />4,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident) <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />$ <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />PER OTH- <br />ANDEMPLOYERS'LIABILITY YIN <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ <br />ANYPROPRIETORIPARTNERIEX <br />OFFICERIMEM EREXCLU ED7ECUTIVE ❑ <br />NIA <br />E.L. DISEASE -EA EMPLOYEE <br />$ <br />- <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />B <br />Excess Auto Liability - CA <br />y <br />RAE500D21B11 <br />10/01/2021 <br />10/01/2022 <br />Any Auto / CSL <br />$3,000,000 <br />Bel£-lnsd Retention <br />$2,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule, may be attached if more space is required) <br />Location Code: 17-145-10-01-01 - Santa Ana Hospitality House Shelter <br />CA -Business Auto is fully Self -Insured per the attached State Certificate. <br />SEE ATTACHED <br />CERTIFICATE HOLDER <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Pl... <br />Santa Ana, CA 92702 <br />ACORD 25 (2016I03) <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 />AUTHORIZED REPRESENTATIVE <br />REj <br />( �ENl' Y <br />The ACORD name and logo are registered marks of ACORD <br />SR ID: 21630631 —a -: 2252947 <br />„se <br />7 <br />Rink ManagmmntDivisian <br />REvieVED &APPR.,IM4 <br />. �OVD BYe. <br />f.1�Q 4MN rRpp,, <br />a , C <br />®' <br />Ruk Management Analyst <br />