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nP In- PC <br />,.&ADATE <br />4 CERTIFICATE OF LIABILITY INSURANCE <br />(MM/DD/YYYY) <br />10/29/10 <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 policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsements . <br />PRODUCER 626-405-8031 <br />Chapman 626-405-0585 <br />License #0522024 <br />P. O. BOX 5455 <br />Pasadena, CA 91117-0455 <br />rim DePriest <br />CON CT <br />NAME: <br />PHONE FAX <br />Ezt : AIC, <br />C No <br />E�IV101L <br />ADDRESS: <br />PRODUCER COMMU-6 <br />U=ER ID #: <br />INSURERS AFFORDING COVERAGE NAIC A <br />INSURED Community Service Programs,Inc <br />1821 E. Dyer Road Ste. 200 <br />Santa Ana, CA 92705 <br />or—L" / C) <br />v /✓1 <br />N— <br />INSURER A: River ort Insurance Company 36684 <br />INSURER B: Everest National 10120 <br />INSURER C <br />INSURER D <br />INSURER E - <br />INSURER F <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 WITH 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, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSRY <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />UBR <br />POLICY NUMBER <br />EFF <br />MMILLICU YY <br />EXP <br />MM/ D/YYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,00 <br />PREMISES Ea occorrenca $ 100.00 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE Ix I OCCUR <br />X <br />RIC0011342 <br />10/01/10 <br />10/01/11 <br />MED EXP (Any one person) $ 5.00 <br />X Sexual Abuse <br />RIC0011342 <br />10/01/10 <br />10/01/11 <br />PERSONAL a ADV INJURY $ 1.000 ,00 <br />00 <br />X <br />PROFESSIONAL <br />GENERAL AGGREGATE $ 3,000.00 <br />CONTRACTUAL LIABILITY <br />10/01/10 <br />10/01/11 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $ 1,000,000 <br />POLICY =PRO LOC <br />lEmp Ben. $ 1,000,00 <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />RIC0011342 <br />COMP = $500 COLL = $500 <br />10/01/10 <br />10/01/11 <br />COMBINED SINGLE LIMIT <br />(Ea accident) $ 1.000.00 <br />X <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Per accident) $ <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />PerPROPERTY accidentDAMAGE $ <br />X <br />X <br />$ <br />NON -OWNED AUTOS <br />$ <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE $ 1,000,005 <br />AGGREGATE $ 1.000.00 <br />A <br />EXCESS LIAB <br />CLAIMS -MADE <br />REL0011343 <br />10/01/10 <br />10/01/11 <br />DEDUCTIBLE <br />$ <br />$ <br />RETENTION $ <br />B <br />COMPENSATIONX <br />WORKERSC MPENSATIONX <br />AND EMPLOYERS' LIABILITYIMT <br />ANYPROPRIETOWPARTNER/EXECUTIVE YIN <br />OFFIC E R/MEMBER EXCLUDED? <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N / A <br />6600000007101 <br />07/01/10 <br />07/01/11 <br />WC STA'rU- OTH- <br />E.L. EACH ACCIDENT $ 1.000.00 <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000 <br />E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />A <br />Employee Dishonest <br />RICOOI1342 <br />10/01/10 <br />10/01/11 <br />& Forgery 650,00 <br />A <br />Property <br />RIC0011342 <br />10/01/10 <br />10/01/11 <br />Contents 249,00 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) !' <br />Re: Positive Action Towards Health Grant. City of Santa Ana, Santa Ana .' a' ' - TU F0P.M <br />Police Department, its officers and employees are named additional insured <br />and any other insurance shall be deemed excess coverage and named insured's <br />insurance shall be primary per the attached CG 2026 end.rseemnt. Workers y <br />m n y r x 1 evidence only. 10 days notice f n <br />tinCovers., <br />GCKIIFIGAIt HVLOER - ,ANGELLATION �� <br />SANPOLI <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Santa Ana Police Department 7 .' 'ACCORDANCE WITH THE POLICY PROVISIONS. <br />60 Civic Center Plaza <br />iia: a. <br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE <br />© 1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />