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OP ID DATE (MMIDDIYYYY) <br />CERTIFICATE OF LIABILITY INSURANCL THOMA-1 09 26/08 <br />ACORD <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO <br />PRODUCER <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />Huntington Pacific ins. Agency <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW <br />7901 Professional Circle <br />Huntington Beach CA 92648 <br />INSURERS AFFORDING COVERAGE NAIC # <br />Phone: 714-841-6283 Fax: 714-842-2538 <br />INSURED <br />INSURER A: Great American Insurance Co. <br />------------- <br />INSURERS:_____ .__.—.. <br />Thomas House Temporary Shelter <br />I INSURER C: <br />P.O. Box 2737 <br />Garden Grove CA 92842-2737 <br />INSURERD: <br />INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. MAY <br />NOTWITHSTOR <br />ANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT T E WHICH THIS CERTIFICATE MAY BE ISSUED S <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />POLICY NUMBER DATE MMIODM DATE MMIDDNY LIMITS <br />LTR NSR TYPE OF INSURANCE EACH OCCURRENCE $ 1 , OOO , OOO <br />GENERAL LIABILITY $100,000 <br />A X X COMMERCIAL GENERAL LIABILITY PAC5603738 10/03/08 10/03/09 PREMISES(Eaoccurence) <br />CLAIMS MADE 7 OCCUR MED EXP (Any one person) $ 5 , 0 0 0 <br />PERSONAL 8 AD, <br />INJURY $ 1,000,000 <br />A X Sexual Misconduct PAC5603738 10/03/08 10/03/09 CENERALACCRECATE $ 1,000,000 <br />PRODUCTS - COMPlOP AGG $ , OOO , OOO <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRO• g POLICY JECT LOC <br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br />(Ea accident) <br />A- AUTO <br />ALL OWNED AUTOS BODILY INJURY $ <br />(Per person) <br />SCHEDULED AUTOS <br />HIRED AUTOS BODILY INJURY $ <br />(Per accident) <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE $ <br />(Per accident) <br />AUTO ONLY - EA ACCIDENT $ <br />GARAGE LIABILITY / hh - - <br />/ EA ACC $ <br />OTHER THAN <br />ANY AUTO -" - AUTO ONLY: <br />AGG $ <br />e �.1 <br />EACH OCCURRENCE $ <br />EXCESSIUMBRELLA LIABILITY <br />AGGREGATE $ <br />OCCUR CLAIMS MADE <br />$ <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ - <br />TDRY LIMITS ER —___— <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ._ <br />ANY PROPRIETORIPARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYE $ <br />OFFICER <br />FFICE JMEMSER EXCLUDED? <br />It yes, describe under E.L. DISEASE -POLICY LIMIT $ <br />SPECIAL PROVISIONS below <br />OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />The City of Santa Ana; it's officers,eaployees,agents,volunteers,and <br />representatives are named as additional insured in respects to the general <br />liability.This insurance is Primary and noncontributory per endorsement CG <br />82 24(ED.12/01)XS.This certificate supercedes any 6 all prior certificates <br />*10 Day Notice of Cancellation for non-payment of premium <br />CERTIFICATE HOLDER CANCELLATION <br />CITSAAA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />City of Santa Ana DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br />Community Development Agency NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />Attn : Frank Hernandez IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />20 Civic Center Plaza REPRESENTATIVES. <br />Santa Ana CA 92702 eurRORR_❑REPRESENTATIVE <br />988 <br />