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ORANCOU-07 RKUMAR
<br />v` vsr.� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMID7/3/201133 )
<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(les) 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 endorsement(s).
<br />:PRODUCER
<br />Chapman
<br />a Division of Arthur J. Gallagher & Co.
<br />Insurance Brokers of California, Inc.
<br />PO Box 5455
<br />CONTACT
<br />NAME:
<br />PHONE Exi:1 (626) 405-8031 (AIC No): 1 (626) 405-0585
<br />._
<br />EMAIL
<br />ADORESs:
<br />-
<br />INSURERSI AFFORDING COVERAGE NAICA
<br />Pasadena, CA91117-0455
<br />,,uRER,. Great American Insurance Company 16691
<br />INSURED
<br />INSURER B: Nonprofits United
<br />INSURER C :
<br />Orange County Conservation Corps
<br />1853 N. Raymond Ave.
<br />Anaheim, CA 92801
<br />'
<br />INSURER D:
<br />INSURER E
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />_ _
<br />THFIS 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 />INSk
<br />LTR
<br />TypE OF INSURANCE
<br />L
<br />I
<br />UBR
<br />D
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />PO4CY E%P
<br />MMIDDIYYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />A
<br />MMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />kXAb
<br />X
<br />PAC5154680-07
<br />7/20/2012
<br />7/20/2013
<br />PREMISES Ea occurrence $ 100,000
<br />MED EXP (Anyone person) $ 5,000
<br />fE"iOnal$1M
<br />PERSONAL It ADVINJURY S 1,000,000
<br />use $1M
<br />GENERAL AGGREGATE $ 3,000,000
<br />GEN'L AGGREGATE LIMPAPPLIES PER
<br />POLICY PRO- LOC
<br />PRODUCTS COMP/OP AGS $ 3,000,000
<br />( $
<br />B
<br />AUTOMOBILE LIABILITY
<br />X ANY AD
<br />ALL OWNED SCHEDULED
<br />AUTOS 'AUTOS
<br />1888
<br />7/1/2013
<br />7/1/2014
<br />COMBINED SINGLE LIMIT 5,000,000
<br />Ea accident)5
<br />BODILY INJURY (Per person) $
<br />BODILY INJURY (Per accident) $
<br />X HIRED AUTOS X NON -OWNED
<br />- AUTOS
<br />PROPERTY DAMAGE
<br />Per accident $
<br />IA
<br />UMBRELLA LIAB OCCUR
<br />EXCESS LIAB CLAIMS-MADEL
<br />-RETENTION$
<br />8/17/2012
<br />8/17/2013
<br />EACH OCCURRENCE $ 1,000,000
<br />AGGREGATE $
<br />DED X 10,000
<br />_
<br />1,000,000 $ 1,000-,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROP RIETOWPARTNER/EXECUTIVE
<br />OFFI C ER/MEMBER EXCLUDED?
<br />(fyes.doryin and
<br />DESCRIPTION
<br />DESCRIPTION OF OPERATIONS below —
<br />NIA
<br />3
<br />1/1/2013
<br />1/1/2074
<br />X WC STAT OTH-
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT s 1,000,000
<br />E. L. DISEASEEAEMPLOYEE$ 1,000,000
<br />EL DISEASE -POLICY LIMIT $ 1,000,000
<br />DESCRIPTION Of OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<br />The City of Santa Ana, its officers, agents, employees and volunteers, and the State of California, its officers, employees, and volunteers are named additional
<br />insured/Funding Source
<br />with respect to the operations of the named insured per the attached CG 2026 endorsement. Such insurance is Primary and
<br />Non -Contributory. Workers Compensation coverage excluded, evidence only.
<br />CERTIFICATE HOLDER CANCELLATION
<br />-
<br />City of Santa Ana, Workforce Investment Board
<br />1000 E. Santa Ana Blvd., Ste. 200
<br />Santa Ana, CA 92701
<br />ACORD 25 (2010/05)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />V" ` `--
<br />U 1988-2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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