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Digitallysigned by Tort Pierson
<br />Tori Pierson Date: 2022.07.1912:e6:0
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<br />A� �® CERTIFICATE OF LIABILITY INSURANCE
<br />(MMIDD
<br />022YY)
<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 />Arthur J. Gallagher f CO.
<br />6Inc.
<br />Insurance Brokers of Suite
<br />505 N Brand Blvd, Suite 600
<br />Glendale CA 91203
<br />CONTACT
<br />NAME: Star Met ry
<br />PNONE . g18.539.8623 ac N.I.818.539.8723
<br />E-MAJL
<br />DOREss: Star Met a .com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Insurance Company of the West
<br />27847
<br />Lice s : 0 26293
<br />INSURED COMMACT-20
<br />Community Action Partnership of Orange County
<br />11870 Monarch Street
<br />INSURER B: Nonprofits' Insurance Alliance of CA
<br />10023
<br />INSURER C:
<br />INSURER 0:
<br />Garden Grove CA 92841
<br />INSURER E
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 1864169753 REVISION NtIMRFR-
<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 />ADDLSUBR
<br />POLICYNUMBER
<br />POLICY EFF
<br />IMWDDNYYYI
<br />POLICY EXP
<br />(MMrDDNYYYlLIMITS
<br />B
<br />X
<br />COMMERCMI-GENERALLIABILITY
<br />CLAIMS -MADE Fx7 OCCUR
<br />Y
<br />V
<br />2022-DO441
<br />7/1/2D22
<br />7/1/2023
<br />EACH OCCURRENCE
<br />$1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$500,000
<br />MED EXP (Any one arson)
<br />$ 20,000
<br />PERSONAL&ADVINJURY
<br />$1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY JECT rX] LOC
<br />GENERALAGGREGATE
<br />$2,000,000
<br />PRODUCTS-COMP/OP AGG
<br />$2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />2022-00441
<br />7/1/2022
<br />7/1/2023
<br />COMBINED SINGLE LIMIT
<br />Ea acculard
<br />$1.000,000
<br />BODILY INJURY (Per parson)
<br />$
<br />ANYAUTO
<br />IX
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />( BODILY INJURY Per accident)
<br />§
<br />XIHIRED
<br />X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Par stationt
<br />§
<br />B
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />2022-00441-UMB
<br />7/1/2022
<br />7/1/2023
<br />EACHOCCURRENCE
<br />$5,000,000
<br />AGGREGATE
<br />$5,000,000
<br />EXCESS UAB
<br />CLAIMS -MADE
<br />DIED I X I RETENTIONS,$
<br />A
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS' LIABILITY YIN
<br />WVE 505610702
<br />7/1/2022
<br />7/1/2023
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />ANYPROPRIETOR/PART,1EWEXECUTIVE
<br />OFFICERIMEMBEREXCWDEDT ❑
<br />N/A
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />B
<br />Director&Ottcers
<br />2022-00441-DO
<br />7/1/2022
<br />7/1/2023
<br />Each Wrongful Act
<br />$1,000,000
<br />Aggregate Omit
<br />Retention
<br />$2,000,000
<br />$5,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Ransom schedule, may be attached if mare space is required)
<br />Nonprofits' Insurance Alliance of CA - A.M. Best #: 011845
<br />Policy: Improper Sexual Conduct
<br />Policy#: 2022-00441
<br />Policy term: 7/1/2022 to 7/1/2023
<br />Carrier: Nonprofits' Insurance Alliance of CA
<br />Per Claim: $1,000,000, Aggregate Limit: $2,000,000
<br />See Attached...
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701
<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.
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<br />REVILVIm&TAffmRDeID Br
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<br />U 7988-ZU75 ACORD G( e
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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