Laserfiche WebLink
To r i Pierson Datea2022.06.09 12:10:33e07 00' <br />/ <br />AC"R " CERTIFICATE OF LIABILITY INSURANCE <br />FDAATE'MMIDD/YYYY) <br />06101 /2022 <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 />CONTACT Lauren Hand <br />NAME: <br />All -Cal Insurance Agency <br />ACNE. Ext : (916) 784-9070 a/c, No): (916) 784-0158 <br />505 Vernon Street <br />E-MAIL lauren@all-calinsurance.com <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />Roseville CA 95678 <br />INSURERA: Nonprofits' Insurance Alliance of California <br />NIAC <br />INSURED <br />INSURER B <br />The Los Angeles Dream Shapers <br />INSURER C : <br />P.O. Box 3831 <br />INSURER D : <br />INSURER E : <br />Orange CA 92865 <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: CL2252511447 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 INSURANCEAUULbUBK <br />INSD <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE FX OCCUR <br />PREM SDA AGES Ea oNcurDmnce <br />$ 500,000 <br />MED EXP (Any one person) <br />$ 20,000 <br />PERSONAL &ADV INJURY <br />$ 1,000,000 <br />A <br />Y <br />Y <br />2022-08609 <br />06/02/2022 <br />06/02/2023 <br />GEN'LAGGREGATE LIMITAPPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />❑ PRO <br />X JECT LOC <br />PRODUCTS-COMP/OPAGG <br />2,000,000 <br />$POLICY <br />Liquor Liability <br />$ 1,000,000 <br />X1 OTHER: No Deductible <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />ANYAUTO <br />A <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />Y <br />2022-08609 <br />06/02/2022 <br />06/02/2023 <br />BODILY INJURY (Pe r accide nt) <br />$ <br />X <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED �/ NON -OWNED <br />AUTOS ONLY X AUTOS ONLY <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LAB <br />CLAIMS -MADE <br />DED I I RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />PER OTH- <br />STATUTE ER <br />ANY PROPRIETOR/PARTNER/EXECUTIVE ElN <br />OFFICER/MEMBER EXCLUDED? <br />/A <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />The City of Santa Ana, its officers, employees, agents and representatives are additional insured with respect to General and Auto Liability per the attached <br />endorsement as required by written contract. Insurance is Primary and Non -Contributory, 30 Days Notice of Cancellation with 10 Days Notice for <br />Non -Payment of premium in accordance with policy provisions. Forms CG 20 26, NIAC-E61, NIAC-E26 and NIAC-Al apply. <br />CERTIFICATE HOLDER CANCELLATION <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 />AUTHORIZED REPRESENTATIVE � � cxtR77�1ekCmn <br />20 Civic Center Plaza . <br />ra <br />Santa Ana CA 92702 GG !_ N p do <br />.�'' �^ez �"�r�tcs�a�x <br />@ 1988-2015ACORD coss<aw n gcncresaeorairsaie <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />