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<br />OP ID: ZJ
<br />CERTIFICATE OF LIABILITY INSURANCE 1 DAT1/02DIYYYY)
<br />11/02!11
<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 endorsements .
<br />PRODUCER
<br />714-997-8100
<br />NAME: CONTACT
<br />(OC) Heffernan Insurance Brkrs 714-460-9935
<br />1855 Katella Ave
<br />Suite 255 PHONE FAX
<br />AIC No Ext : A/C No):
<br />,
<br />Orange, CA 92867-4459 AE-MAIL
<br />DDRESS:
<br />Jim Cochran-Post Merger PRODUCER HUMAOP1
<br />CUSTOMER ID #:
<br /> INSURERS AFFORDING COVERAGE NAIC #
<br />INSURED Human Options INSURER A: GREAT AMERICAN INSURANCE 16691
<br />Mindy Weinheimer INSURER B: Great American Alliance
<br />5540-A Trabuco Road INSURER C :
<br />Irvine, CA 92620
<br />INSURER D
<br /> INSURER E :
<br /> INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 />INSR
<br />LTR TYPE OF INSURANCE ADDL SUB
<br />POLICYNUMBER POLICY EFF
<br />MMIDD/YYYY POLICY EXP
<br />MM/DDIYYYY LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br />A X COMMERCIAL GENERAL LIABILITY X PAC1669863 09/23/11 09123/12 DAMAGE REN ED
<br />PREMISES Ea occurrence 100,000
<br />$
<br /> CLAIMS-MADE 1XI OCCUR MED EXP (Any one person) $ 5,00
<br /> X Sexual Misconduct PAC1669863 09/23/11 09/23/12 -PERSONAL &ADV INJURY $ 1,000,00
<br /> GENERAL AGGREGATE $ 2,000,00
<br /> GEN'L AGGREGATE LIMIT APPLIES PER j PRODUCTS - COMP/OP AGG $ 1,000,00
<br />
<br />
<br />RO LOC
<br />POLICY P
<br />JECT [7
<br />
<br />Emp Ben.
<br />
<br />$ 1,000,00
<br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00
<br />
<br />0
<br />2 .?`
<br />(Ea accident)
<br />A ANY AUTO PAC1669863
<br />A
<br />5
<br />?6 ]JIR,
<br />BODILY INJURY (Per person)
<br />$
<br /> ALL OWNED AUTOS PR • ? BODILY INJURY (Per accident) $
<br /> SCHEDULED AUTOS ,-
<br />-PROPERTY DAMAGE
<br />
<br />X
<br />HIREDAUTOS
<br />(Peraccident) $
<br /> X NON-OWNEDAUTOS L?SA STOR
<br />ey $
<br /> Atto
<br />Cit rn
<br /> y , $
<br /> UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,00
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,00
<br />B UMB1669864 09/23/11 09/23/12
<br /> DEDUCTIBLE $
<br /> X RETENTION $ 10,000 $
<br /> WORKERS COMPENSATION WC
<br />-
<br />OTH-
<br /> AND EMPLOYERS' LIABILITY LIMI_
<br />T ER
<br />Y
<br /> Y / N
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />?
<br />N I A E.L. EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
<br /> If yes, describe under
<br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
<br />A Prof. Liability PAC1669863 09123/11 09/23/12 Occurence 1,000,00
<br />A EmployeeDishonesty PAC1669863 09123/11 09/23/12 Occurence 1,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Project: Funding to provide counseling services in the City of Santa Ana.
<br />City of Santa Ana, its officers, employees, agents, volunteers and
<br />representatives are named as additional insured (primary) on General
<br />Liability policy per attached endorsement.
<br />I.CR I IrIVA I C r1VLL1CR I..ArK LLLAI IUN
<br />CIOFSAN
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Frank Hernandez
<br />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701
<br />©1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
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