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NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head forinsurance. A Heart for Nonprofits, NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA (NIAC) www.insurancefornonprofits.org COMMERCIAL UMBRELLA POLICY DECLARATIONS PRODUCER:. POLICY NUMBER: 2021.24712-UMB Bowermaster.& Associates Insurance Agency, Inc. 10805 Holder St. Ste. 350 RENEWAL OF NUMBER: 2020-24712-UMB-NPO Cypress, CA 90630 Item 1 NAME OF INSURED AND MAILING ADDRESS: Illumination Foundation; Integrated Community Healthcare Solutions; Home4Health Broadway, LLC; Illumination Housing, LLC 1091 N. Batavia Street Orange, CA 92867 Item 2 POLICY PERIOD: FROM 9/15/2021 TO 9/15/2022 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE BUSINESS DESCRIPTION: Provides services and temporary housing for the homeless IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY, Item 3 THE ANNUAL AND MINIMUM PREMIUM DUE AT INCEPTION: Item 4 LIMITS OF INSURANCE: $51,864 a. Occurrence / Accident / Injury / Claim Limits (where applicable): ........ ................................... 7,000,000 1) Each Occurrence -Commercial General Liability and Products - Completed Operations Liability 11) Each Accident - Business Auto Liability !it) Each Injury- Liquor Liability - iv) Each Claim - Employee Benefits Liability . b. Each Claim - Directors and Officers Liability.......................................................................... 7,000,000 C. Each Claim - Improper Sexual Conduct and Physical Abuse Liability ..................................... 2,000,000 d. Each Claim - Social Service Professional Liability.................................................................. 7,000,000 Aggregate limits e. Commercial General Liability, Business Auto Liability, Products- Completed Operations Liability, Liquor Liability, and Employee Benefits Liability Aggregate (where applicable): ..................................................................................... ............................ 7,000,000 _ f. Directors and Officers Liability Aggregate...........................................:.................................... 7,000,000 - g. Improper Sexual Conduct and Physical Abuse Liability Aggregate ........................................ 2,000,000 h. Social Service Professional Liability Aggregate....................................................................... 7,000,000 Item 5 RETROACTIVE DATES- SEE SCHEDULE OF UNDERLYING INSURANCE FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY AT INCEPTION (NUMBER AND EDITION DATE): - CU 21 33 01 15,.NIAC-E003 UMB 08 20, NIAC-E133 UMB 05 20, NIAC-E180 UMB 0121, NIAC-E253 UMB 08 21, NIAC-E42 UMB 09 19, SCHEDULE A 0180, UMB 231 06 16, UMB 232 06 16, UMB-100 05 21, UMB61 05 13 - COUNTERSIGNED: 9/20/2021- BY 1 11 (AUTHORIZED REPRESENTATIVE) THESE DECLARATIONS, THE ATTACHED SCHEDULE OF UNDERLYING INSURANCE, TOGETHER WITH THE ATTACHED SCHEDULE OF FORMS AND ENDORSEMENTS, AND ANY FORMS AND ENDORSEMENTS WE MAY LATERATTACH TO REFLECT CHANGES, MAKE UP AND COMPLETE THE ABOVE NUMBERED POLICY. Notice: This risk pooling contract is issued by a pooling arrangement authorized by California Cor 5005.1. The pooling arrangement is not subject to all of the insurance laws of the State of Califorr regulation by the Insurance Commissioner. Insurance guaranty funds are not available to pay clal becomes insolvent. NIAC - UMB / 2-99 IUak Diirielan ,yj II F REVIEWED&�APPRWaJBY: Risk Management Analyst 011