BIG BROTHERS BIG SISTERS OF ORANGE COUNTY 3-2012

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ACCROl CERTIFICATE OF LIABILITY INSURANCE 1DATE 0 YYY) o /01/201 /l/z THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFI9At?EI!42- l) _ ( _ IMPORTANT: If the certificate holder is an ADDITIONAL INSSU`R D, the of cy s st be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-909-243'-8260 CONTAG 1 T _. e NAME:.' : Hays of California Insurance Services - Ontario- PHONE" FAX (AIC, Nb;f7tff+ (AIC, No): Empire Towers IV ADDRIESS: 3800 Concours, Suite 3400 PRODUCER Ontario, CA 91764 CUSTOMER ID #: Kelly Peterson INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: Nonprofits Insurance Alliance Big Brothers/Big Sisters of Orange County INSURER B: Oak River Insurance Company 14131 Yorba Street, Suite 200 INSURER C Tustin, CA 92780 INSURER D: INSURER E : INSURER F GUVFKAGFN CFKIIFICAiF NIIMRFR• 29416096 RFVISItIN NIIMRFR- 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. ILTR TYPE OF INSURANCE = SUBR POLICY NUMBER MM/DI DYE MMIDD/YYYY LIMIT S A GENERAL LIABILITY 20120647ONPO 02/11/12 02/11/13 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES S ( ( DAMAGE Ea occu RENTED rrence) S 100,000 CLAIMS-MADE X OCCUR MED EXP (Any one person) S 10,000 PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEML AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 3,000,000 X POLICY PJE, RO LOC S A AUTOMOBILE LIABILITY 20120647ONPO 02/11/12 02/11/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED A11T05 BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ A X UMBRELLA LIAB X OCCUR 20120647ONPO 02/11/12 02/11/13 EACH OCCURRENCE S 3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE S 3,000,000 DEDUCTIBLE $ X RETENTION $ 10, 000 S WORKERS B 2200054868-121 02/11/12 02/11/13 ' WCSTATU- X O AN D EMPLOYERS LIABILITY YIN TO RY LIMITS ER ANY PROPRIETOR/PARTNERlEXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 N / A OFFICER/MEMBER EXCLUDED' El (Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Santa Ana is named as Additional Insured per attached form CG 20 26 07 04. M kV li/'11Y V GLLM I I V IY - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE USA I Kelly Peterson nparxa © 1988-2009 ACORD CORPORATION. All rights reserved. (2009/09) The ACORD name and logo are registered marks of ACORD ACORD 25 2994411660 096 6