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Item 52 - Award Youth Agreements Funded with Federal Workforce Innovation and Opportunity Act Funds
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06/21/2022 Regular & Special HA
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Item 52 - Award Youth Agreements Funded with Federal Workforce Innovation and Opportunity Act Funds
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8/15/2023 9:43:31 AM
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8/15/2023 9:42:05 AM
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City Clerk
Doc Type
Agenda Packet
Agency
Clerk of the Council
Item #
52
Date
6/21/2022
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ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/D0/YYYY) <br />� 12/8/2020 <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 pollcy(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 cerUflcate holder in lieu of such endorsement(s). <br />PRODUCER Arthur J. Gallagher & Co. Insurance Brokers of California, Inc. LIC# 0726293 <br />1255 Battery Street #450 <br />San Francisco CA 94111 <br />INSURED NONPUNl-01 <br />Orange County Conservation Corps <br />1853 North Raymond Avenue <br />Anaheim, CA 92801 <br />COVERAGES CERTIFICATE NUMBER· 1153230747 <br />CONTACT NAME: <br />��gN��o ---••: I f'.,O� Nol: E-MAIL ADDRESS: <br />INSURER/SI AFFORDING COVERAGE <br />INSURER A: NonProfits' United Workers' Comoensation Group <br />INSURER a: Safetv National Casualtv Corooration <br />INSURER c: Resoonse lndemnitv Comoanv of California <br />INSURER D: <br />INSURER E: <br />INSURER F: <br />REVISION NUMBER· <br />NAIC# <br />15105 <br />10970 <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 \MTH 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR <br />A <br />C <br />TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY <br />\ CLAIMS-MADE □ OCCUR <br />GEN'L AGGRE GATE LIMIT APPLIES PER: � □PRO-□ POLICY JECT LOG <br />OTHER: AUTOMOBILE LIABILITY <br />-ANY AUTO -OWNED � SCHEDULED AUTOS ONLY AUTOS -HIRED � NON-OWNED AUTOS 'ONLY f---AUTOS ONLY <br />UMBRELLA LIAB � OCCUR -EXCESS LIAS CLAIMS-MADE <br />DEO I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY V/N ANYPROPRIETOR/PARTNER/EXECUTIVE □ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below XSWC -Buffer Layer xswc <br />ADDL •····o <br />N/A <br />SUBR '""'D POLICY NUMBER POLICY EFF I IMM/DD/YYYYI ,�g��'b�Vv1 LIMITS <br />EACH O CCURRENCE $ ��E'��is 9E���J�rr°enoo' $ <br />MED EXP (Any one person) <br />PERSONAL & ADV INJURY <br />GENERAL AGGR EGATE <br />PRODUCTS -COMP/OP AGG $ <br />$ <br />(OMBINEu SINGLE LIMIT Ea accldentl $ <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Per accident) $ <br />rp����c�i�RAMAGE $ <br />$ <br />EACH O CCURRENCE <br />AGGREGATE $ <br />$ <br />NPU-WCG 001-2021 1/1/2021 1/1/2022 X I �i�TUTE ) I OTH-ER <br />E .L. EACH ACCIDENT $500,000 <br />E.L. DISEASE -EA EMPLOYEE $500,000 <br />E.L. DISEASE -POLICY LIMIT $500,000 ABL 1000013-00 1/1/2021 1/1/2022 XS of $500,000 $250,000 (EL & WC) <br />SP4064079 1/1/2021 1/1/2022 XS of $750,000 $2,000,000 (EL) XS of$750,000 Statutory 0/'JC) <br />DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is reqUlred) <br />CERTIFICATE HOLDER <br />City of Santa Ana <br />20 Civic Center Plaza <br />4th Floor <br />Santa Ana CA 92701 <br />ACORD 25 (2016/03) <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />@ 1988-2015 ACORD C <br />The ACORD name and logo are registered marks of ACORD <br />RiskMan,g,me,,!Divislon <br />REVlEWED & APPROVED av,F�R.�� <br />Exhibit 2
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