Laserfiche WebLink
CERTIFICATE OF WORKERS' COMPENSATION COVERAGE <br />NonProfits' United Workers' Compensation Group <br />610 Fulton Avenue, Suite 200 <br />Sacramento, CA 95825 Phone: (916) 868-6231 <br />Arthur J. Gallagher & Cc Insurance Brokers Of California, file <br />Fax: <br />(916) 880-5251 <br />1255 Battery Street #450 <br />San Francisco, CA 94111 <br />INSURED <br />Orange County Conservation Corps <br />1853 North Raymond Avenue <br />Anaheim, CA 92801- <br />DATE <br />Jun 4, 2021 <br />M <br />ICATE IS ISSUED AS MATTER OFINFORMATION ONLY <br />RS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />E DOES NOT AMEND, EXTEND OR ALTER THE <br />AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />INSURER A: NOnProflts' United Workers' Compensation Group <br />INSURERS Safety National Casualty Corp [NAIL#15105] <br />INSURER c: Response Indemnity Company of California [NAIL # 109701 <br />INSURER D: <br />INSURER E: <br />THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE AFFILIATE MEMBER NAMED ABOVE conditions <br />THE POLICY PERIOD Nthe 20 DICATEID 1eNOTWITHSTANDING ANY <br />REQUIREMENT, TERM, OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE <br />COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS <br />SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR TYPE OF COVERAGE <br />GENERAL LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE OCCUR <br />GENERAL AGGREGATE LIMIT APPLIES PER: <br />POLICY PROJECT LOC <br />AUTOMOBILE LIABILITY <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NONAWNED AUTOS <br />WORKERS'COMPENSATION <br />A AND <br />EMPLOYERS LIABILITY <br />OTHER <br />C XSWC -Buffer Layer <br />B XSWC <br />POLICY NUMBER <br />NPU-WCG 001-2021 <br />POLICY I ruuCY <br />EFFECTIVE DATE EXPIRATION <br />LIMITS <br />EACH OCCURRENCE <br />FIRE DAMAGE (Anyone fire) <br />MED EXPENSE (Anv one <br />PERSONAL & ADV INJURY <br />-_ <br />GENERAL AGGREGATE <br />PRODUCTS-COMP/OP AGG <br />COMBINED �SINGLE LIMIT <br />BODILY INJURY <br />(Per person) <br />BODILY INJURY <br />(Per accident) <br />E.L. EACH ACCIDENT <br />E,L. DISEASE <br />EL. DISEAS- GE <br />XS of $500,000 <br />XS of $750,000 <br />XS of $750,000 <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAUPROVISIONS <br />Agreement Number A-2020-142 Project: Adult and Dislocated Worker Training <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza 4th Floor <br />Santa Ana, CA 92701 <br />ABL 1000013-00 <br />SP4064079 <br />I/1/2021 1/1/2022 <br />1/1/2021 <br />1/I/2022 <br />1/1/2021 <br />I/l/2022 <br />500,000 <br />$ 500,000 <br />$250,000 (EL & WC) <br />$2,000,000 (EL) <br />Statutory (WC) <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 />Risk MW491 entDivislon <br />Based on ACORD 25 (2016/03) r.sr r,.fq REVIMM&APPROV@By. <br />