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CERTIFICATE OF WORKERS' <br />COMPENSATION COVERAGE <br />E <br />3an7 2021 <br />PRODUCER <br />NOnProlim' United Workers COmpenSUiDu Group <br />THIS CERTIFICATE 15 ISSUED AS MATTER OF INFORMATION ONLY <br />610 Fulton Avenue, Suite 200 <br />AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />SueramerRo, CA 95825 <br />Phone: (916) 868-6231 <br />CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />Fax: (916) 880-5251 <br />COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Arthur J. Gallagher & CO Insurance Brokers oFC.I forma, <br />hm <br />1255 Battery Street #450 <br />San Francisco, CA 9411I <br />I <br />INSURERS AFFORDING COVERAGE <br />INSURED <br />INSURER A NonProfits' United Workers' Compensation Group <br />Habitat for Humanity of Orange County <br />2200 Ritchey Street <br />INSURER a Safety National Casualty <br />Natil Clty Corp [NA1C#15105 1 <br />Santa Ana, CA 92705 <br />INSURER C: Response Indemnity Company of California [NAIC N 109701 <br />INSURER 0: <br />INSURER E <br />COVERAGES This Certificate Is not intended to specify all endorsements coverages terms Conditions and exclusions of the pol'des shown <br />THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE AFFILIATE MEMBER NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY <br />REQUIREMENT, TERM, OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE <br />COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS <br />MISS <br />LTR <br />TYPEOFCOVERAOE <br />POLICY NUMBER <br />POLICY <br />EFFECTIVE DATE <br />POLICY <br />EXPIRATIDN <br />OATS <br />LIMITS <br />GENERAL UABLLITY <br />EACHOCCURRENCE <br />COMMERCIAL GENERAL LIABILITY <br />FIRE DAMAGE (My ane are) <br />$ <br />CLAIMS MADE OCCUR <br />MED EXPENSE (Any one <br />$ <br />GENERAL AGGREGATE UNIT APPLIES PER: <br />PERSONAL& ADVINJURY <br />$ <br />POLICY PROJECT I LOG <br />GENERALAGGREGATE <br />$ <br />PRODUCTSCOMP/0P AGO <br />$ <br />AUTOMOBILE LIABILITY <br />- <br />COMBINEDSINGLELIMIT <br />(Each umid.tj <br />$ <br />ALL OWNED AUTOS <br />BODILY INJURY <br />erson <br />(Perperson) <br />$ <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />BODILY INJURY <br />S <br />X I PERT <br />U <br />ETA IS <br />T <br />WORKERS' COMPENSATION E.L. EACH ACCIDENT $ 500,000 <br />A AND NPO-WCGO0I-202I 1/1/2021 1/1/2022 <br />EMPLOYERS LIABILITY E.L DISEASE -EA EMPLOYEE $500,000 <br />DISEASE -COVERAGE <br />LIMIT <br />$ SOO,000 <br />C I XSWC-BufferLayer ABL1000013-00 11112121 1/1/2022 IXS.f$500,000 $250,000(EL & WC) <br />B XSWC SP4064079 ]/1/2021 1/1/2022 1 XS of$750,000 $2,000.000(EL) <br />XS of $750,000 1 Statutory (WC) <br />DESCRIPTION OF OPERATIONSJLOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAUPROVISIONS <br />Waiver of Subrogation provided by Endorsement No. NPLTWCG-1-rHOC-05R <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED <br />IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />Based on ACORD 25 (2016103) r 14 02 <br />2021 <br />M. LAMBERT <br />