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Francine R.
<br />A ® Villareal
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />'. Digitally signed by Francine R.
<br />Villareal
<br />�E(io IYY)DATI`0I9/31
<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(les) 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 />NAME: Llzelte OrozcoPHONE
<br />FAX
<br />• 714-733-6248 Alc No:
<br />ABBE S• loroZCO bOWermaster.Com
<br />Cypress CA 90630.
<br />INSURERS AFFORDING COVERAGE
<br />NAICq
<br />INSURER A: Philadelphia Indemnity Insurance
<br />18058
<br />INSURED ILLUFOU-01
<br />Illumination Foundation
<br />1091 N. Batavia Street
<br />INSURER B: Redwood Fire & OBSUaIt Insurance
<br />11673
<br />INSURER C: Nonprofits' Insurance Alliance of California
<br />11384
<br />INSURERD:
<br />Orange CA 92867
<br />INSURER E :
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 622668538 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 />ADDLSUSR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />C
<br />X
<br />COMMERCIALGENERAL LIABILITY
<br />Y
<br />2021-24712
<br />9115/2021
<br />9/15/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE � OCCUR
<br />RENT D
<br />DAMAGEEa occ rr
<br />PREMISESS
<br />-
<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 />AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑JET LOC
<br />GENERAL AGGREGATE
<br />$3,000,000
<br />GEN'L
<br />X
<br />PRODUCTS - COMP/OPAGG
<br />$3,000,000
<br />$
<br />OTHER,
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />2021-24712
<br />9/15l2021
<br />9/1512022
<br />SINGLE LIMIT
<br />$1,000,00'ntX
<br />JURY(Par per son)
<br />$OWNED
<br />ANY AUTO
<br />SCHEDULED
<br />ONLY AUTOSX
<br />JURY Pereccitlenl
<br />$AUTOS
<br />HIRED X NON -OWNED
<br />ONLY AUTOS ONLY
<br />W-LIMITD
<br />Y DAMAGE
<br />entC
<br />$AUTOS
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />2021-24712-UMB
<br />9/15/2021
<br />9/15/2022
<br />CURRENCE
<br />$7,000,000EXCESS
<br />TE
<br />$7,000,000
<br />LIAR
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />g
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />ILWC209336
<br />1/1/2021
<br />1/1/2022
<br />X STATUTE ERH
<br />E.L. EACH ACCIDENT
<br />$1,000.000
<br />ANYPROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERIMEMBEREXCLUDED4 ❑
<br />NIA
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />Ifyes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />A
<br />Commercial Cyber Liability
<br />PHSD1575498
<br />111512121
<br />9/11/2022
<br />Agg:$3,000,0001Each
<br />$1.000,000
<br />C
<br />Improper Sexual Conduct
<br />2021-24712
<br />9/15/2021
<br />9/15/2022
<br />Agg:$1.000,0001Each
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES ACORD 101, Additional Remarks Schedule, maybe 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 20 Civic Center Plaza, 4th Floor AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701Ptak w
<br />r�iAmea�l,
<br />RE&ED�&&AAp 2cvEoSY:
<br />1988-2015 ACORD CF4AAOW R, 11.l,&Wt
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />RukManagement Analyst
<br />
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