|
Francine R. Digitally signed by Francine
<br />9. Villareal
<br />\/illarool Can: 2022.01,2717:24:48
<br />AC")?6r CERTIFICATE OF LIABILITY INSURANCE u
<br />`�
<br />DAW&DDIYYYY)
<br />1/2612022
<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 />Cypress CA 90630
<br />"MIT CT
<br />NAME: LlZelte OrOZCO
<br />PHONE 714-733-6248 FAX No:
<br />ADDRIESS: IorOZcO bowermaster.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURERA: Philadelphia Indemnity Insurance
<br />18058
<br />INSURED ILLUFOU-01
<br />The Illumination Foundation
<br />1091 N. Batavia Street
<br />INSURER B: Non )rofltS' Insurance Alliance of California
<br />11384
<br />INSURER C: Cypress Ins Cc
<br />10855
<br />INSURER D:
<br />Orange CA 92867
<br />INSURER E :
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 1919030540 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 />ILTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />INSD
<br />POLICYNUMBER
<br />POLICYEFF
<br />(MMIDDNYYYI
<br />POLICY EXP
<br />MMIDDIYYYYI
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />Y
<br />2021-24712
<br />9/15/2021
<br />9/15/2022
<br />EACHOCCURRENCE
<br />$1,000,000
<br />D MA0E TO RENTED
<br />PREMISES Ea occurrence
<br />$500,000
<br />X
<br />MED EXP(Any one person)
<br />$20,000
<br />Prof Llabllity
<br />PERSONAL &ADV INJURY
<br />11,000.000
<br />GEN'L
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑PECROT- 1-1LOC
<br />J
<br />GENERAL AGGREGATE
<br />$3,000,000
<br />PRODUCTS-COMP/OP AGG
<br />$3,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />2021-24712
<br />9/15/2021
<br />9/15/2022
<br />OMBBIN DISINGLELIMIT
<br />$1,000,000
<br />BODILY INJURY(Per person)OWNED
<br />ANY AUTO
<br />SCHEDULEDBODILY
<br />AUTOS ONLY AUTOS
<br />IX
<br />INJURY Peraxident
<br />( )HIRED
<br />$
<br />X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per axldent
<br />$
<br />B
<br />X
<br />UMBRELLA LIAR
<br />N
<br />OCCUR
<br />2021-24712-UMB
<br />9/1512021
<br />9/1512022
<br />EACH OCCURRENCE
<br />$7,000,000
<br />AGGREGATE
<br />$7,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED I I RETENTION$
<br />$
<br />C
<br />WORKERS
<br />AND EMPLOYERS' COMPENSATION
<br />LIABILITY YIN
<br />ANYPROPRIETOMPARTNERJEXECUTIVE
<br />OFFICERJMEMBEREXCLUDEDY
<br />NIA
<br />ILWC310553
<br />111/2022
<br />1/1/2023
<br />X PER
<br />EERH
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yee, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />A
<br />B
<br />Commercial Cyber Liability
<br />Improper Sexual Conduct
<br />PHSD1575498
<br />2021-24712
<br />9/15/2021
<br />9/15/2021
<br />9/1512022
<br />9/15/2022
<br />Age $3,000,0001
<br />Agg:$1A00,000IEach
<br />$1,000,000
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional RemarksSchedule, maybe attached if more space is required)
<br />RE: HPRP Contract #A-2021-046, A-2021-228
<br />City of Santa Ana, their officers, employees, agents, volunteers and representatives are Additional Insured with respects to General Liability per attached form;
<br />Primary and Non -Contributory wording applies per attached form.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701
<br />USA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE
<br />y 1LekMmugemm$DWe[on
<br />fi g§ REVIEWED&APPROVEI
<br />11 � � F4! tYxahE r� N
<br />c Risk Management Analyst
<br />
|