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i Digitally signed by Francine R.
<br />Francine R. Vlllareay—l^yDmNareal
<br />AC ®® CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DDIYYYY>
<br />V I 7/16/9n91
<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 />Arthur J. Gallagher & Co.
<br />Insurance Brokers of CA., Inc.
<br />505 N Brand Blvd, Suite 600
<br />Glendale CA 91203
<br />NAME• Kim Tran
<br />PNONE 818.539.8618 ac e:818.539.8617
<br />N
<br />EMMESS, kim tran a' .com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Insurance Company of the West
<br />27847
<br />Licenself,0726293
<br />INSURED COMMACT-20
<br />Community Action Partnership of Orange County
<br />11870 Monarch Street
<br />INSURER B: Nonprofits' Insurance Alliance of CA
<br />INSURERC:
<br />INSURER D:
<br />Garden Grove, CA 92841
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES . CERTIFICATE NUMBER: nRAn7FiA1 A RPVIRIAM MIIMRGD•
<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 />TYPEOFINSURANCE
<br />ADDLSUBR
<br />POLICYNUMBER
<br />POLICY EFF
<br />MM/DO
<br />POLICY EXP
<br />MMIDD
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />M OCCUR
<br />Y
<br />2021-00441
<br />7/1/2021
<br />7/1/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />-EfTMCLAIMS-MADE A ET RENTED
<br />PREMISES Ea peourrencol
<br />E600,000
<br />MED EXP lArry one person)
<br />$20.000
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />AGGREGATE LIMIT APPLIES PER,
<br />POLICY PECT LOC
<br />GENERA -AGGREGATE
<br />$3,000,000
<br />GEN'L
<br />X
<br />PRODUCTS-COMP/OPAGG
<br />$3,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />2021-00441
<br />711/2021
<br />7/1/2022
<br />COCe MBINEDISINGLELIMIT
<br />$1,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Par Person)
<br />$
<br />I
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per —accident)
<br />$
<br />X
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Par accident
<br />$
<br />8
<br />e
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />2021-00441-UMB
<br />7/112021
<br />7/112022
<br />EACH OCCURRENCE
<br />$5,000,000
<br />AGGREGATE
<br />$5,000,000
<br />X
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED
<br />X
<br />RETENTION$n
<br />$
<br />A
<br />WORKERSAND COMPENSATI N YIN
<br />ANYPROPRIETORPARTNEWEXECUTIVE
<br />NIA
<br />VVVE 505610701
<br />7/1/2021
<br />7/1/2022
<br />X STATUTE OERµ
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory In NHREXCLUOED?
<br />(Mandatory In NH)
<br />If yes, describe under
<br />EL. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />8
<br />Direclor&OMcers -
<br />2021-00441-DO-NPO
<br />7/1/2021
<br />7/1/2022
<br />Each gWgronfd Ad
<br />R¢lentiate Limit
<br />$1,000,000
<br />$2,000,000
<br />$6,000
<br />DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more a pace is respired)
<br />Nonprofits' Insurance Alliance of CA - A.M. Best #: 011845
<br />Policy: Improer Sexual Conduct
<br />Policy#: 202TOO441
<br />Policy term: 7/1/2021 to 7/112022
<br />Carrier: Nonprofits' Insurance Alliance of CA
<br />Per Claim: $1,000,000, Aggregate Limit: $3,000,000
<br />See Attached...
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza,
<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 />©1988.2015 AC
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />100n.Pm.
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<br />REVIedyao A, APPROVED BY:
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