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A-2021 107-07 B { Digitally signed by Frandne R.
<br />Francine R. Villaregl"Viereal
<br />Ac R ® CERTIFICATE OF LIABILITY INSURANCE
<br />L..�.�". 7115/2021
<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 />Art hur J. Gallagher & Co.
<br />Insurance Brokers of CA., Inc.
<br />505 N Brand Blvd, Suite 600
<br />Glendale CA 91203
<br />CONTACTNAME: Kim Tran
<br />ONE 118.539.8618 AX No 818.539.8617
<br />MAIL
<br />aooREss: klm tran a ,com
<br />INSUI AFFORDING COVERAGE
<br />NAICif
<br />INSURER A: Insurance Company of the West
<br />27847
<br />License#: 0726293
<br />INSURED COMMACT-20
<br />Community Action Partnership of Orange County
<br />11870 Monarch Street
<br />INSURER is: Nonprofits' Insurance Alliance of CA
<br />INSURER C:
<br />INSURER D.:
<br />Garden Grove, CA 92841
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 989075818 REVISION NUMeeR-
<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 />INTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYW
<br />POLICY EXP
<br />MM/DDIYYYY
<br />LIMITS
<br />B
<br />GENERAL LIABILITY
<br />Y
<br />2021-00441
<br />7/12021
<br />7/1/2022
<br />$1,000,000
<br />4COMMERCIAL
<br />CLAIMS -MADE I OCCUR
<br />RE TED
<br />Eaoccunence
<br />$500,000
<br />ny one erson)
<br />$20,000
<br />REACHOCCURRENCEE
<br />&ADV INJURY
<br />$1,000,000
<br />GEN'L AGGREGATE LI MIT APPLIES PER:
<br />GGREGATE
<br />$3,000,000
<br />POLICY❑-❑-COMPIOP
<br />ECT LOG
<br />AGG
<br />$3,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />2021-00441
<br />7/1/2021
<br />7/1/2022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />BODILY INJURY(Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOSBODILY
<br />IX
<br />INJURY(Per accident)
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Pareccldenl
<br />$
<br />B
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />2021-00441-UMB
<br />7/1/2021
<br />7/1/2022
<br />EACH OCCURRENCE
<br />$5,000,000
<br />X
<br />AGGREGATE
<br />$5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I X I RETENTION$ R
<br />$
<br />1
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />WVE 505610701
<br />7/1/2021
<br />7/112022
<br />X STATUTE OERH
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />ANYPROPRIETOWPARTNERlEXECUTIVE ❑
<br />OFFICER/MEMBEREXCLUDEDP
<br />NIA
<br />E.L. DISEASE EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in bin
<br />If yes, dascdbe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE- POLICY LIMIT
<br />$1,000,000
<br />B
<br />Director&Officers
<br />2021-00441-DO-NPO
<br />7/1/2021
<br />7/1/2022
<br />Each Wrongful Act
<br />$1,000,000
<br />Aggregate Limit
<br />Retention
<br />$2,000,000
<br />$5,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requlrad)
<br />Nonprofits' Insurance Alliance of CA - A.M. Best #: 011845
<br />Policy: Improper Sexual Conduct
<br />Policy#: 2021-00441
<br />Policy term: 7/1/2021 to 7/1/2022
<br />Carrier: Nonprofits' Insurance Alliance of CA
<br />Per Claim: $1,000,000, Aggregate Limit: $3,000,000
<br />See Attached...
<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 />20 Civic Center Plaza, AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701 '. b ,, Rta�ManAgnnelttD[vu
<br />4, �Y REaLvtEo6r APPNOV82
<br />©1988.20TS TACORD l �� - r 4.runuYa�a / ,
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD gr,k xranannn.,,»n�An„
<br />
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