ORANGE COUNTY ASIAN AND PACIFIC ISLANDER COMMUNITY ALLIANCE

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0,/ (ct M__�G ORANCNT-01 GAIYAPPA CERTIFICATE OF LIABILITY INSURANCE A5/17/20 3TE �) 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 Chapman a Division of Arthur J. Gallagher & Co. Insurance Brokers of California, Inc. PO Box 5455 Pasadena, CA 91117-0455 CONTACT NAME. PHONE 1 626 405�031 F"X 1 (626) 405-0585 c No EMT ( � AIC No e E-MAIL : INSURER(SI AFFORDING COVERAGE NAICA INSURER A: Great American Insurance Company 16691 INSURED INSURERS: _ INSURER C: Orange County Asian & Pacific Islander Community Alliance 12900 Garden Grove Blvd #214A INSURER D: INSURER E: Garden Grove, CA 92843 INSURER F: _ 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 CONTRACTOR 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. OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE A SIR R POLICY NUMBER MMIIDDIIYYY MMDDD�P LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 A X COMMERCIAL GENERAL LIABILITY X PAC033097800 10/16/2012 10/15/2013 MED FYP(A,, one person) $ 5,000 CLAIMSMADEOCCUR PERSONAL B ADV INJURY $ 1,000,000 X Professional Lia Inc X Sexual Abuse Incl GENERAL AGGREGATE $ 2,000,000 GE AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 2,000,000 $ X POLICYPRO- LOC CT AUTOMOBILE LIABILITY COMBI NED SINGLE LIMIT Ea amkent $ 1,00D,000 BODILY INJURY (Per person) $ A ANY AUTO PAC033097800 10/15/2012 10/15/2013 BODILY[ NJURY (Per accident) S ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ AGGREGATE $ EXCESS UAB CLAIMS -MADE DED RETENTION $ $ AND EMPLOYERS' LIABILITY AND EMPSCOMPENSATIONYERS'LIILIT ANY PROPRI EfOWPARTNER/EXECUTIVE Y❑ OFFICERIMEMSER EXCLUDED? (Mandatory in NH) NIA _ WC SLIMIT OTH- T ftY LIMITS ER EL. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYE $ $ It yes, desuibe under DESCRIPTIONOFOPERATIONSbelcw EL.DISEASE-POLICY LIMIT A Employee Dishonesty PAC033097600 10/15/2012 10/15/2013 Deductiible: $1,000 50,000 q Forgery&Alteration PAC033097800 1011512012 10I15/2013 Deductible: $1,000 50,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 401, Additional Remarks Schedule, if more space is required) Certificate holder is named additional insured with respect to the operations of the named insured. T. TO gpPR�V�� E. SIORCK LISA Attorne 5kantstCity _ CERTIFICATE HOLDER ., _ CANCELLATION - __�/ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1000 E. Santa Ana Blvd, Suite 201 Santa Ana, CA 92701 - - -- - AUTHORIZED REPRESENTATIVE j ACORD 25 (2010105) © 1988-2010 ACOR The ACORD name and logo are registered marks of ACORD CORPORATION. All rights reserved. 000016