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<br />Ac6ii ® <br />CERTIFICATE OF LIABILITY INSURANCE DATE (M),VDDIYYYY) <br />1212912010 <br /> <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(ies) 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 endorsement(s). <br />PRODUCER CONTACT <br />NAME <br />MARSH RISK& INSURANCE SERVICES PHONE <br />SAN FRANCISCO, CA 94014 E - AIC o <br />CALIFORNIA LICENSE NO. 0437153 and <br />' <br />' E-MAIL <br />ADDRESS: <br />NonProfils <br />United Workers <br />Comp Group <br />RODUCER <br />P <br />Suite 200 <br />4311 Street <br />Sacramento Ca 95814 10 4: <br />, <br />, <br />398879-WCASWC-11-12 INSURERS AFFORDING COVERAGE NAIC 0 <br />INSURED INSURER A : NonProtits' United Workers' Compensation Group <br />Orange County Conservation Corps (1560) <br />1853 N <br />Ra <br />ond A ACE American Insurance Company <br />INSURER 8: 22667 <br />. <br />ym <br />ye. <br />Anaheim, CA 92801 INSURER C : <br /> INSURER D : <br /> INSURER E : <br /> INSURER F : <br />COVERAGES CERTIFICATE NUMBER: SEA-001916406-01 REVISION NUMBER: 1 <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 />INSA <br />LTA TYPE OF INSURANCE ADD <br />jam S BR <br />wa <br />POLICY NUMBER POLICY EFF <br />MWODIYYYY POLICY EXP <br />MWODNYYY LllAliS <br /> GENERAL LIABILITY _ EACHOCCURRENCE $ <br /> <br /> <br />COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence _ <br /> <br />$ <br /> CLAIMS-MADE r_1 OCCUR MED EXP (AnV one person) $ <br /> PERSONAL &ADV INJURY $ <br /> Q ??( <br />W GENERALAGGREGATE $ <br /> GEN'LAGGREGATE <br />LIMIT <br />APPLIES PER., 'r? <br />EjJ/ <br />' ?y <br />r PRODUCTS -COMPIOPAGG $ <br /> P <br />RO- <br />POLICY PRO LOC P <br />? $ <br /> AUT OMOBILE LIABILITY <br />CK COMBINED SINGLE LIMIT <br />$ <br /> R <br />ST O (Ea accident) _ <br /> ANY AUTO L?SA qty Attorn y BODILY INJURY (Per person) <br />$ <br /> ALL OWNED AUTOS nt <br />ASSista BODILY INJURY (Per accident) $ <br /> SCHEDULED AUTOS <br />HIRED AUTOS PROPERTY DAMAGE <br />(Per accident) $ <br /> NON-OWNED AUTOS $ <br /> S <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DEDUCTIBLE S <br /> RETENTION $ <br />A WORKERS COMPENSATION <br /> <br />AND EMPLOYERS' LIABILITY NPU-WCG 001-2011 01/0112011 01101/2012 WC STAT'U X oTH- <br />0, LIM,: <br /> <br />ANY PROPRIEfOR/PARTNER(EXECUTiVE a <br />N /A <br />E-L. EACH ACCIDENT <br />500 <br />600,000 <br />$ <br /> OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />E.L. DISEASE - EA EMPLOYE <br />$ 500,000 <br /> t YSs describe under <br />DESCRIPTION OF OPERATIONS below <br />F L DIS SE - POLICY LIMIT 5w,000 <br />$ <br /> <br />B <br />Excess Workers' Compensation <br />WCLC45714496 <br />01/0112011 <br />01/0112012 t <br />000,x $500,000 WC <br />000'000 $500,000 EL <br />DESCRIP17oN OF OPERATIONS/ LOCATIONS /VEHICLES (AttachACORD 101, Additional Remarks Schedule, If more space isrequhed) <br />Santa Ana Workforce Investment Board <br />Fran Julzi <br />1000 East Santa Ana Boulevard <br />Santa Ana, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />of Marsh USA Inc. <br />Lea Warburton <br />©1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD