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Digitally signed by Ton Pierson
<br />TOrI Pierson Date: 2022A638 09:19.04
<br />-or0v
<br />A� �® CERTIFICATE OF LIABILITY INSURANCE
<br />DA 6M5/zo22 Y)
<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 />Bowermaster &Associates
<br />10805 Holder St
<br />Ste 350
<br />CONTACT LIZBtte OfOZCO
<br />NAME:PHONE
<br />FAX
<br />AIC No Ert: 714-733-6248 pIC No:
<br />AIL
<br />ADDRESS: lorozm@bowermaster.com
<br />Cypress CA 90630
<br />INSURERS AFFORDING COVERAGE
<br />NAIC9
<br />INSURER A: Philadelphia Indemnity Insurance
<br />18058
<br />INSURED ILWFOU-0I
<br />The Illumination Foundation
<br />1091 N. Batavia Street
<br />INSURER B: Nonprofits' Insurance Alliance of California
<br />11384
<br />INSURER C: Cypress Ins Co
<br />10855
<br />INSURED
<br />Orange CA 92867
<br />INSURERR E
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 1663127581 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADD
<br />BR
<br />POLICYNUMBER
<br />MMIDDY�
<br />Mxxmm NYPY
<br />LIMITS
<br />B
<br />X
<br />CON MERCIALGENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />Pror Liability
<br />Y
<br />2021-24712
<br />9/15/2021
<br />9/15/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />A A ET RENEU
<br />PREMISES KLNI nence
<br />$500,000
<br />X
<br />GEN'L
<br />X
<br />MED EXP (Any one person)
<br />$ 20,000
<br />PERSONAL B ADV INJURY
<br />$1,000.000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY [::]PRO, ECT ❑OC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />$3,000,000
<br />PRODUCTS-COMP/OPAGG
<br />$3,000,000
<br />$
<br />B
<br />AU70MOBILELIABILITY
<br />X
<br />X
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED X NON N
<br />AUTOS ONLY AUTOSS ONLY
<br />2021-24712
<br />9/15/2021
<br />9/15/2022
<br />COMBINEOSINGLE LIMIT
<br />Ea accident
<br />§1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY Per accident
<br />( )
<br />$
<br />PROPERTY DAMAGE
<br />Par accident
<br />$
<br />B
<br />X
<br />UMBRELLALIAB
<br />EXCESS LIAR
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />2021-24712-UMB
<br />9/15/2021
<br />9/15/2022
<br />EACH OCCURRENCE
<br />$7,000,000
<br />AGGREGATE
<br />$7,000,000
<br />DED I I RETENTION$
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABIDTY YIN
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE ❑
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, descnbe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />ILWC310553
<br />1/112022
<br />1/1/2023
<br />X STATUTE 10
<br />ERH
<br />E.L. EACH ACCIDENT
<br />$1,D00,GOO
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,D00,000
<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 />9/15/2022
<br />9/15/2022
<br />Age: $3,000,000/Each
<br />Agg:$1,000,000/Each
<br />$1,000,000
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required)
<br />City of Santa Ana, Its officers, employees, agents, and volunteers are Additional Insured with respects to General Liability per attached endorsement form;
<br />Primary and Non -Contributory wording applies per attached endorsement form.
<br />30-day notice of Cancellation is provided per policy provisions.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Fir
<br />Santa Ana CA 92702
<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 />ll MmrgandUHion
<br />LI-.`°:,. I�Y4v,ID6ArvRw®Br.
<br />ACORD 25 (2016103)
<br />V T988-Z015 AUUKU LA .."".......... r'--'--"•
<br />The ACORD name and logo are registered marks of ACORD
<br />
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