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J • OP ID DATE (MMIDD/YYYY) A-CORD CERTIFICATE OF LIABILITY INSURANCE THOMA -1 02/10/12 PRODUCER Huntington Pacific Ins. Agency 7901 Professional Circle Huntington Beach CA 92648 Phone: 714- 841 -6283 Fax:714- 842 -2538 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE NAIC # INSURED Thomas House Temporary Shelter P.O. BOX 2737 Garden Grove CA 92842 -2737 INSURER A: Great American Insurance Co. POLICY NUMBER INSURER B: POLICY EXPIRATION DATE MMlDD/YY INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNbK LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYY POLICY EXPIRATION DATE MMlDD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X X COMMERCIAL GENERAL LIABILITY PAC5603738 10/03/11 10/03/12 PREMISES(Eaoccurence) $ 100,000 CLAIMS MADE 7 OCCUR MED I (Any one person) $ 5 , 000 PERSONAL & ADV INJURY $1,000,000 A PAC5603738 10/03/11 10/03/12 X Sexual Misconduct GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $1,000,000 X I POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ IF I (Per accident) GARAGE LIABILITY TO AUTO ONLY - EA ACCIDENT ANY AUTO j� AS I OTHER THAN EA ACC $ �4OVE+' F� AUTO ONLY: AGG $ EXCE BREL �+ EACH OCCURRENCE $ CUR CLAIMS MADE 11 'C —Is C S� ORv� G pttorn y AGGREGATE $ $ t C1ty ISIS to DEDUCTIBLE $ is RETENTION $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEB- OFFICER/MEMBER EXCLUDED? If yes, describe under - --- _ - - -- — --- -- SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS The City of Santa Ana; it's officers, employees,agents,volunteers,and representatives are named as additional insured in respects to the general liability.This insurance is Primary and noncontributory per endorsement CG 20 26 (07/04) . *10 Day Notice of Cancellation for non - payment of premium CERTIFICATE HOLDER CANCELLATION City of Santa Ana Community Development Agency Attn:Frank Hernandez 20 Civic Center Plaza Santa Ana CA 92702 ACORD 25 (2001108) CI TSAAA I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI< DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.