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a0 31 s No. 0 10 1 F. 2ooT <br />R. 5.2004` 1:35PM UDI CORP HR/LEGAL <br />Arthur J. Gallagher & Co. <br />The Gallagher Centre, Two Pierce Place, hasca, IL W143-3141 e30/773-3800 <br />CERTIFICATE OF INSURANCE <br />Name and Address of Certificate Holder <br />CITY OF SANTA ANA•COMMUNITY Y <br />DEVELOPMENT AGENCY (M-25) <br />20 CIVIC CENTER PLAZA <br />SANAT ANA CA 92702-1968 A <br />Brothers of the Christian Schools and Af0patea <br />1205 Windham Parkway <br />RomecAle, IL 60448-1679 <br />Phone-(800) 807-0100 <br />And including: 1134066 <br />.TY OF ST VINCENT DE PAUL <br />Company Policy Number Applicable <br />Expiration <br />(Sae Reverse Side) <br />United National Insurance Company CP0065461 A,B,C.H <br />8/1 /2004 <br />London and Various Carriers CB 100103.01 A <br />8/t/2004 <br />TNCRAG )be XS10219-06 B,C.H <br />8/1/2004 <br />Zurich American Insurance Company <br />(Exclude: TX, VA) BAP8377761.00 C <br />8/1/2004 <br />Zurich American Insurance Company <br />(Virginia Only) SAP9377702.00 C <br />8/1/2004 <br />Zurich American Insurance Company <br />(Texas Only) TAP9377763-00 C. <br />8/1/2004 <br />Safety National Casualty Corporation AGG7595-I1. D <br />1/1/2005 <br />Zurich American Insurance Company WC9377758-00 E <br />1/1/2005 <br />Zurich American Insurance Company WC9377759-00 F <br />1/1/2005 <br />Hartford Steam Boiler FBP4909989 G <br />8/1/2004 <br />REMARKS <br />Evidenoe of General Liability Coverage (B) $1,000,000 each occurrence <br />— <br />"i<_o V )'L <br />(with cross liability coverage) for Society of Saint Vincent DePoul. <br />180 S Cypress, Orange, CA with respects to City of Santa Ana for an <br />J� <br />application for a Community Development Block Grant (HUD Grant) <br />F <br />and adding the City of Santa Ana, its officers, ageerp, <br />insured <br />representatives, employees and volunteers as additional <br />solely, strictly and specifically in relation to the above grant- This <br />coverage is primary over any coverage or self -insured cover"". of <br />City of Santa Ana. Workers Compensation coverage is not evidenced on <br />this certificate. Certificate is amended to give 30 days written <br />notice for cancellation. <br />Cancellation: <br />Should any of the above -described policies be canceled before the expiration date thereof, the Issuing <br />company will endeavor to mall 30 days written notice to the above -named cerdficato holder, but failure <br />to mail such notice shall impose no obligation or liability of any kind upon the company <br />TH15 CERTIFICAYE 15 KWED AS A MATTER OF INFORMATION ONLY AND CONFFM NO RIGHTS UPON THE CUMFICATE HOLDER. THIS <br />CERTIRCATE DOES NOT AMEND, EX72ND, OR ALTER THE COVERAGE AFFORDED BY THE POUCIES LISTED ABOVE. <br />ARTHUR J. GALLAG14M a CO <br />By <br />Cems.iru puffin. CP'CU <br />Ekwudre Vice President <br />ate; 04/06/2004 baz <br />