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NONPROFITS <br />INSURANCE <br />ALLLkNCE OF CALIFORN[A <br />A Head for Insurance. A Heartfar Nonprofits. <br />NONPROFITS INSURANCE ALLIANCE <br />OF CALIFORNIA (NIAC) <br />www.insurancefomonprofits.org <br />COMMERCIAL UMBRELLA POLICY DECLARATIONS 11 <br />PRODUCER: <br />Comprehensive Insurance Services <br />26429 Rancho Parkway South Suite 120 <br />Lake Forest, CA 92630 <br />Item 1 NAME OF INSURED AND MAILING ADDRESS: <br />POLICY NUMBER: 2021-45659-UMB <br />RENEWAL OF NUMBER: 2020-45659-UMB-NPO <br />Kidworks Community Development Corporation <br />1902 W Chestnut Ave. <br />Santa Ana, CA 92703 <br />Item 2 POLICY PERIOD: FROM 7/1/2021 TO 7/1/2022 <br />AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE <br />BUSINESS DESCRIPTION: Services to the underserved in Santa Ana <br />IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS <br />POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. <br />Item 3 THE ANNUAL AND MINIMUM PREMIUM DUE AT INCEPTION: $1,937 <br />(premium includes Terrorism Coverage - Certified Acts: $50 <br />but only for policies that indicate coverage on Schedule A - Schedule of Underlying Insurance) <br />Item 4 LIMITS OF INSURANCE: <br />a. Occurrence / Accident / Injury / Claim Limits (where applicable): ............................................ 1,000,000 <br />i) Each Occurrence - Commercial General Liability and Products - <br />Completed Operations Liability <br />ii) Each Accident - Business Auto Liability <br />III) Each Injury - Liquor Liability <br />iv) Each Claim - Employee Benefits Liability <br />b. Each Claim - Directors and Officers Liability.......................................................................... Excluded <br />C. Each Claim - Improper Sexual Conduct and Physical Abuse Liability ..................................... Excluded <br />d. Each Claim - Social Service Professional Liability .................................................................. Excluded <br />Aggregate limits: <br />e. Commercial General Liability, Business Auto Liability, Products- Completed Operations <br />Liability, Liquor Liability, and Employee Benefits Liability Aggregate <br />(where applicable): .................................................................................................................. 1,000,000 <br />f. Directors and Officers Liability Aggregate................................................................................ Excluded <br />g. Improper Sexual Conduct and Physical Abuse Liability Aggregate ........................................ Excluded <br />h. Social Service Professional Liability Aggregate....................................................................... Excluded <br />Item 5 RETROACTIVE DATES - SEE SCHEDULE OF UNDERLYING INSURANCE <br />FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY AT INCEPTION (NUMBER AND EDITION DATE): <br />CU 2130 01 15. CU 21 33 a 01 15, CU 2133 a 01 15, IL 09 99 12 20, NIAC-EO03 UMB 08 20, NIAC-EI80 UMB 0121, NIAC-E42 UMB 09 19, SCHEDULE A 0180, UMB <br />23106 16, UMB 232 06 16, UMB-100 05 21, UMB166 12 88, UMB62 05 13 <br />by RfskMwaga WdIDWon i <br />9 �.%n REviewD&APPROYDBY <br />a Afi Am44 w <br />RA Management Specialist i'S <br />