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OP ID• PC .a►`c —oar °° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/Y`/YY) 03/15/1 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON�LY[�A7N�D CONFERS RIGHTS UPON THE CERTIFICATE HOLDER. THIS TN�O NSURANCER OTHE�ISSUING BELOW.CATHIS CERT FICATEFOFn DOESA NIOTLCITUTE- A�CO�1 RRi4CT'H�TWEEN NSURER(S) TAUTHOR ZIED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INS ,1 h ;policy(ies,),IrF}IS al��tdorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may req�iLe�a r)CandorsemanL ;AssL�llLement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). _ `' ` `" PRODUCER 626 - 405 -8031 Chapman License #0522024 626 -405 -0585 P. O. Box 5455 Pasadena, CA 91117 -0455 CONTACT NAME: PHONE FAX gMPJL Ert : ac Ne ADDRESS: PRODUCER BACKT -1 c T MER ID #: INSURER S) AFFORDING COVERAGE NAIC # INSURED Back to Natives Restoration INSURERA: NIAC 10023 PO Box 6539 Irvine, CA 92612 -6539 N- "aQ�\�Q3� INSURER B A INSURER C X INSURER D: 201021765NP0 INSURER E 10/01/11 pREM15E5 Ea occurrence INSURER F MED EXP (Any one parson) $ 2D,DOD COVERAGES CERTIFICATE NUMBER: REVISION NUMBER_ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRR TYPE OF INSURANCE The City of Santa Ana APPRO V Ell AS fr� F Ri(CCORDANCE WITH THE POLICY PROVISIONS. 1� POLICY NUMBER POLICY EFF MM /DD /1'Yl'Y POLICY EXP MM /DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0 DD A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X 201021765NP0 10/01/10 10/01/11 pREM15E5 Ea occurrence $ 500,000 MED EXP (Any one parson) $ 2D,DOD PERSONAL SADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY PRO T LOC $ AUTOMOBILE LIABILITY (OMaBeNdEeDI SING LE LIMIT $ 1,DUD,000 ANY AUTO BODILY INJURY (Par person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ A SCHEDULED AUTOS HIRED AUTOS 201021765NP0 10/01/10 10/01/11 PROPERTY DAMAGE (Per accident) $ X X NON -OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEDUCTIBLE S $ RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY �. / N ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? � N / A T RY IMIT ER EL EACH ACCIDENT $ E_L. DISEASE - EA EMPLOYE $ (Mantletory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Sexual Abuse 201021765NP0 10/01/10 10/01/11 Occurrent 1,000,000 Aggregate 1 ,000,000 DESCRIPTION OF OPERATONS / LOCATONS /VEHICLES (Attach ACORD '101, Atldltlonel Remarks Schetlule, H more space Is required) Re- Use of City Premise at 600 E. Memory Lane, Santa Ana, CA 92705. The City of Santa Ana, Its officers, employees, agents and volunteers are named additional insured with respect to the operations of the named insured per the attached CG 2026 endorsement. Such insurance is primary and non- contributo er the attached endorsement. CERTIFICATE HOLDER CANCELLATION CITYSAI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Santa Ana APPRO V Ell AS fr� F Ri(CCORDANCE WITH THE POLICY PROVISIONS. 1� 20 Civic Center Plaza AUTHORIZED REPRESENTATVE Santa Ana, CA 92702 �_ Laura Assis[a[�[lC =ily AL[orney ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD