ORANGE COUNTY ASIAN AND PACIFIC ISLANDER COMMUNITY ALLIANCE

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SPECSER-01 JOHNYJU d►� Ro CERTIFICATE OF LIABILITY INSURANCE °AT"M"°°"""' 6/11/2013 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 CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 _ - - -- -- Willis Insurance Services of California, Inc. clo 26 Century Blvd. P.O. Box 305191 Nashville, TN 37230-5191 INSURED Special SdrWd f6r Grbb#% r INSURER C Attn: Beth De Los Santos -- 605 W. Olympic Blvd., Suite 600 INSURER D: Los Angeles, CA 90015I INSURER E XL 945-7378 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. .INSR LTRTYPE OF INSURANCE R INSR' Whi POLICY EFF POLICY EXP POLICY NUMBER (MMIDDIVYYY) — (MMIDDIYYYY LIMITS GENERAL LIABILITY-�--- I EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY'( PREMISES (Ea occurrence? $ CLAIMSMADE OCCUR "'. I$ MED EXP(Any one person) � — PERSONAL 8 ADV INJURY $ AGGREGATE $ ' GENT AGGREGATE LIMIT APPLI ES PER I�GENERAL PRODUCTS - COMP/OP AGO $ 17 POLICY � PRO- ECT _ $ ~ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ $ ANY AUTO BODILY INJURY (Per person) _ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident) ( ) $ I NUT OWNED HIRED AUTOS AUTOS ' _� GE PRO(PER ACCIDENT) (PER ACCCENT7 $ ' Ji ----- I $ i UMBRELLA LIAR "OCCUR � '; ,EACH OCCURRENCE $ I �I. EXCESS LIAB CLAIMS -MADE I _ AGGREGATE $ $ DED RETENTION$ _ WORKERS COMPENSATION '.. ':� X WC STATU- OTH-1 AND EMPLOYERS' LIABILITY YIN T DRYLIMITS' ER $ 1,000,000 '.A AN V PROPRIETOR/PARTNEwexecunvE RWD500028501 10/112012 10(1(2013 IE.L. EACH ACCIOENr OFFICER/MEMBER EXCLUDED? l .NIA -- 1,DDD,DDB (Mandatory in NH) EL. DISEASE - EA EMPLOYEE'$ If yes, describe under -- — — -- 11 $ DESCRIPTIONOFOPERATIONSbelow _ DISEASE -POLICY LIMIT I _-_E.L _ .1,000,0001 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER _ Santa Ana Youth Council Workforce Investment Board Attn: Julie Castro-Cardenas 1000 E. Santa Ana Blvd., Suite 200 (Santa Ana CA 92701 TO FO"R ;1 .APPROVED �S � LSTORCK Assistant E. Cdevy Attorn�; ' I, CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0ei�7P71-7-_ © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD