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NONPROFITS <br />INSURANCE <br />-W ALLIANCE OF CALIFORNIA <br />A Head for Insurance. A Heart for Nonprofits. <br />NONPROFITS INSURANCE ALLIANCE <br />OF CALIFORNIA (NIAC) <br />www.insurancefornonprofits.org <br />COMMERCIAL UMBRELLA POLICY DECLARATIONS <br />PRODUCER: POLICY NUMBER: 2022-00441-UMB <br />Arthur J. Gallagher & Co. Ins Brokers of CA, Inc. <br />505 North Brand Blvd. Suite 600 RENEWAL OF NUMBER: 2021-00441-UMB-NPO <br />Glendale, CA 91203 <br />Item 1 NAME OF INSURED AND MAILING ADDRESS: <br />Community Action Partnership of Orange County <br />11870 Monarch St. <br />Garden Grove, CA 92841 <br />Item 2 POLICY PERIOD: FROM 7/1/2022 TO 7/1/2023 <br />AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE <br />BUSINESS DESCRIPTION: Community services <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: $29,553 <br />(premium includes Terrorism Coverage - Certified Acts: $938 <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): ............................................ <br />5,000,000 <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 .......................................................................... <br />1,000,000 <br />C. Each Claim - Improper Sexual Conduct and Physical Abuse Liability ..................................... <br />5,000,000 <br />d. Each Claim - Social Service Professional Liability .................................................................. <br />5,000,000 <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): .................................................................................................................. 5,000,000 <br />f. Directors and Officers Liability Aggregate................................................................................ 1,000,000 <br />g. Improper Sexual Conduct and Physical Abuse Liability Aggregate ........................................ 5,000,000 <br />h. Social Service Professional Liability Aggregate....................................................................... 5,000,000 <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 21 30 01 15, CU 21 33 a 01 15, CU 21 33 s 01 15. IL 09 99 12 20, NIAC-EO03 UMB 08 20, NIAC-E133 UMB 05 20, NAG-E180 UMB 01 21, NIAC-E253 UMB 08 21, <br />NIAC-E42 UMB 0919, SCHEDULE A 0180, UMB 23106 16, UMB 232 06 16. UMB-100 05 21, UMB61 05 13 <br />RbkMmga mAdm <br />1 _ Remy &A r Rr. <br />Rukhbnagemmt UerialAitle pie <br />