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<br />CERTIFICATE OF WORKERS' <br />COMPENSATION COVERAGE DATE <br />Deg 19. aom <br />PRODUCER THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY <br /> AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br />NonProfts' United \>, orkers' Compensation Group THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br /> COVERAGE AFFORDED BY THE POLICIES BELOW- <br />Suite 340 <br />I3erklex Way <br />344 Thomas L <br />, <br />. <br />Oakland, CA 9461 Z <br /> Phone: (5771 >i 1-6717 INSURERS AFFORDING COVERAGE <br /> Fax'1~301_'7d-9571 <br />INSURED INSURERA. Nonprofits' l.inited Workers' Compensation Group <br />Orange County Conservation Corps v Corporation <br />INSURER e Safet} National C'asualt <br /> _ <br />1853 North Raymond Avenue <br />Anaheim. CA 92801-1117 INSURER C. <br /> INSURER D-. <br /> INSURER E. <br />COVERAGES This Certificate is not intended t0 specify all endorsements, coverages, terms, conditions and exclusions of the policies shown. <br />THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE AFFLIATE MEMER NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY <br />TERM OR CONDITION OF ANY CONTRAC <br />REQUIREMENT T OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE <br />, <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 />TYPE OF COVERAGE <br />POLICY NUMBER POLICY <br />EFFECTIVE DATE POLICY <br />EXPIRATION DATE LIMITS <br />LTR <br /> GENERAL LIABILITY EACH OCCURRENCE <br /> COMMERCIAL GENERAL LIABILITY ~ FIRE DAMAGE (Any one fire <br /> CLAIMS MADE OCCUR , <br />~Q~rS` <br />~, MED EXPENSE IAny one person) <br /> GENERAL AGGREGATE LIMIT APPLIES PER: ~ <br />~ <br />^^ <br />~J ~S` I PERSONAL & ADV INJURY <br /> POLICY PROJECT LOC .,~ll <br />,r <br />v,~~^ S ~ "} ~ ~ .P4~ GENERAL AGGREGATE <br /> a <br />`,O <br />r ~ <br />~h <br /> JJG~ PRODUCTS-COMPIOP AGG <br /> AUT OMOBILE LIABILITY Q COMBINED SINGLE LIMIT <br /> ~ <br />, (Each accident <br /> <br />ANY AUTO v <br />q ) $ <br /> <br />n _ <br /> <br />ALL OWNED AUTOS ~ <br />'~ ~ Y <br />BODILY INJURY <br /> O erson i <br />(Per <br /> SCHEDULED AUTOS ~ p <br /> HIRED AUTOS BODILY INJURY <br /> leer accidenT <br /> <br />NON-OWNED AUTOS ; <br /> PROPERTY DAMAGE <br /> (Per accidenti <br /> <br /> WC STAT X OTHER <br /> LIMITS <br /> WORKERS' COMPENSATION <br />N <br />PL'-WCG 001-2005 <br />1%1/08 <br />1/1/09 E.L. EACH AccIDENT $ 500,000 <br />A AND <br />EMPLOYERS LIABILITY E L DISEASE - EA EMPLOYEE S 500,000 <br /> E.L. DISEASE -COVERAGE LIMIT $ SOO,000 <br /> <br />B OTHER <br />Excess Workers- Compensation <br />SP-l Y94-CA <br />1!1 /08 <br />1.'1 /09 <br />$2s.ooo,ooo x $soo,ooo we <br /> $1,000.OOG x $500,OOG EL <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIALIPROVISIONS <br />Evidence of V~'orkers~ Compensation Coverage: <br />CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION <br /> NPUWC'G-UCC'C'-Ode SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br /> BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER VNLL <br /> ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE <br /> HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE <br />City of Santa Ana NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS <br />Workforce Investment Board AGENTS OR REPRESENTATIVES. <br />P. O. Box 1985 M-?3 <br />Santa Aaa- CA 927(12 AUTHORIZED REPRESENTATIVE <br /> <br /> <br />Based on ACORD 25-S (7197) <br />