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�- -���o - / � .� -� �. <br />OP ID• PC <br />'`'t,�°.� °' CERTIFICATE OF LIABILITY INSURANCE <br />°ATE(M1 /JOD/YYY`n <br />02/2A/11 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TH)S <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES hOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sj, AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If tho co Hl(laate holder is an AookTIONAL INSURED, the pollcy(las) niLlst be elldorsod. if SUBROGATION tS WAIVED, stll)Ject to <br />the terms Rnd cwid ltlons of the policy, cerlaln pollclea may roqulre an endorsomont. A eta lemon[ on this certiticate does not confer rlDhts to the <br />certiticate holder In IIetI of such eETdorso_ntonE s . _ <br />PRODUCER � 82B -4O$ -8031 <br />Chapman 820 -405 -0685 <br />License N0622024 <br />P. O. BOX 6465 <br />Pasadena, CA 91117 -0456 <br />E; T <br />_ <br />/�c � c. Hot: <br />���)� -- <br />noD :��_, <br />od.ORANG -7 <br />_ <br />INSURB a AFF ORDt7f0 GOVERAQE <br />t1AIC Y <br />II+sURw Orangewood Childron's <br />Foundation <br />1676 E, 17th Street <br />Santa Ana, CA 92706 <br />IwsuRERn:Non rofits' Insurance AI[lance <br />10023 <br />HlsuaERa;EVerest National Insurance Co <br />10120 <br />It1aVRERC,FidelFty &Deposit Co Maryland __ <br />38305 <br />msufteRO,Oroat American Insurance Co <br />1G681 <br />1I19URER E <br />$ 20,00 <br />1 SURER F <br />_ <br />$ 1.000,00 <br />COVE RAC3E3 CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICES OF INSUfiANCE L}STED 6ELOW HAVE BEEN ISSUL'D TO THE INSURED NAMED ABOVE FOR TFiE POLICY PERIOD <br />INOICATEO. NOTVNT HSTANDINO ANY REQUIREMENT, TERtt OR CONDITION OF ANY CONTRACT OR OTHER OOCUA(ENT 1MTH RESPECT TO WHICH THIS <br />CERTIFICATE fJIAY BE ISSUED OR htAY PERTAIN, THE INSURANCE AF FORGED BY THE POLICIES DESC(31BED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUS {DNS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MIRY HAVE BEEN REDUCED BY PA]D CLAIl+IS-� <br />1 <br />TYPE OF1+19URAHCB <br />POLICY NU BE <br />ME O <br />LIIdIT3 <br />A <br />GENEFIAL UASILITY <br />X COhiME RCIAL GENE RAL LIABILITY <br />CLAIMS MADE � OCCUR <br />X Profesalo Rel LIAb <br />X <br />201 11 2 7 7 8NP0 <br />03!01111 <br />03!01!12 <br />EACI4 CCCV RRENCE <br />S 1,000,UB <br />° E�,II�q�F7 Eaa�E a <br />$ GOO,OO <br />MED EXP An one rson <br />$ 20,00 <br />PERSO+LtI d AOV INIURY <br />_ <br />$ 1.000,00 <br />X <br />AOuaB Llanlllty <br />GENERAL AGGii L "GATE <br />$ 3,000,00 <br />OENL AGGREGATE <br />POLICY <br />LIAEIT APPLIkiS PER: <br />P O- LOC <br />PROOVCTS •COM PpP A00 <br />S 3,000.00 <br />$ <br />A <br />AUTOFIOBILE <br />LIAUILITY <br />ANY AUro <br />ALL OWNED AUTOS <br />6CHE WLEO AVT03 <br />EIIRF.DAVT09 <br />NON -0WNEOAUT09 <br />2 0111 277 8NP0 <br />�` <br />y-� N <br />T_� ^�II �v�Y <br />03101!11 <br />�] <br />O ��}, <br />03f01l12 <br />CO!ABINED 911JGLE UREIT <br />(Ee eocldanl) <br />$ 1,000,00 <br />BODILY INJURY (Per pefaon) <br />S <br />BODILY INJURY (Per OtUdonl) <br />S <br />PROPERTY OMIAOE -- <br />(POfe WdenU <br />S <br />X <br />X <br />U /BBRELLA LIAB <br />Excess LlAB <br />OCCUR <br />CLAIt.i S'LUDI' <br />S.� <br />`�ISA �'• <br />psslstant Ctty <br />R(j {` <br />AttoxneY <br />// <br />�/ <br />EACH CCCVRRENCE <br />3 <br />_ <br />AGGREGATE _ <br />s _ <br />_ <br />DEDUCTIBLE <br />RETEMION S <br />$ <br />S <br />B <br />\YORI(Efta COh1PENSA710N <br />AIEOEMPLOYERS•LlABILI7Y yRf <br />AN1 'PROPN£TOR/PARTNERIEXECUTIVE� <br />OFFl CC-rVME7.IBER EXCLUDED? <br />(tfmdalory In NH) <br />If yes desMhe uMer <br />DESCRIPTION OF OPERATIONS boiorr <br />E17A <br />0000001013111 <br />03 /01/11 <br />03/01712 <br />'C STA V- <br />EA. etCH ACCIDENT <br />$ 1,000,00 <br />E.L. DISEASE -EA EMPLOYE <br />$ 1,000,00 <br />E.L. Dt9EASE - POLICY LI7.11T <br />$ 1,000,00 <br />C <br />p <br />CrlR10 Covora9u <br />Proporly Covora£le <br />CCP00818e8e6 <br />PAC7676S480b <br />02/01!11 <br />03lofl1l <br />02lOiN2 <br />03101/12 <br />Blk! Cont 66a,00 <br />Empt Dlah 600,00 <br />DESCRIPRON OF OPERATIONS/ LOCATIDN3! VENICLE9 (Allath ACORO 101, Addlllonal Re,narko bchedulo, 11 mono apace Is required) <br />Tlio Clty of Santa Arta, It's of(Icers empptoyoes, aDelTte, voluliteera and <br />rep reaentalives aro Hamad as an dddillonal lnaured as resPecta uabmty <br />arlslnD from the oporatlona of the named lnaured per the attached CG 2028 <br />endorsement. Workers compensation coveraDe ezciuded, oVldenco only. <br />L:bK I11'IGAI t IYVLV tit vNIViCI -LH 1I�IV _ <br />CITYSAN <br />SHOULD ANY OP THE ABOVE DE3C RIBEO pOLIC l68 BE CANCELLED BEPORE <br />THE EXPIRATION PATE THEREOF, NOTICE WILL BE OE LIVERED IN <br />City of Santa Ana ACCORDANCE WITH THE POLICY PROV)S[O N8. <br />20 Civic Celttar Plaza - <br />Santa Ana, CA 92701 AUT KORI2ED REPRESENTATNE <br />� 1988 -2000 ACORD CORPORATION. All rinlTta reserved. <br />ACORD 26 (2009/00) The ACORD namo and l00o are reDlatered marks of ACORD <br />