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b., • . 14`IC_°ROF CERTIFICATE OF LIABILITY INSURANCE DAT 01 /18DIYYYV) 01/18/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 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 endorsements . PRODUCER 714 - 841 -6283 Huntington Pacific Ins. Agency 7901 Professional Circle 714-848-0450 Huntington Beach, CA 92648 Robin Hatfield NAMTACT PHONE qIC No: Elfl no eLSS. PRODUCER THOMA -1 CUSTOM ERIC, INSURERS AFFORDING COVERAGE NAIC9 INSURED Thomas House Temporary Shelter P.O. Box 2737 Garden Grove, CA 92842 -2737 INSURER A:Great American Insurance Co. PAC5603738 -06 INSURER B: _ INSURER C S 1,000,08 INSURER D' S 100,08 INSURER E: $ 5,00 PERSONALS ADV INJURY $ 1,000,00 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 TYPE OF INSURANCE ADDL R POLICYNUMBER POLICY EFF POLICVEXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE [ OCCUR X Professional Liab X PAC5603738 -06 10103112 10103/13 EACH OCCURRENCE S 1,000,08 PREMISES Ea occurrence S 100,08 MED EXP (Anyone person) $ 5,00 PERSONALS ADV INJURY $ 1,000,00 X Sexual Misconduct GENERAL AGGREGATE S 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY PRO LOC FGT PRODUCTS - COMPIOP AGO $ 1,000,00 S A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS PAC5603738 -06 10/03112 10/03/13 COMBINED SINGLE LIMIT (Ee ecoldent) S BODILY INJURY (Par person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X S S UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS MADE !P �OV£� n' .k V �1ow P iii~ EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA L SC) �tSA E' S jA5515 ta(1t 0i ``tt C" Lt0 Y00Y j ` WG STATU- OTH- T RYLIMITS ER E.L. EACH ACCIDENT $ EL. DISEASE EA EMPLOYE $ E . DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS [VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) The City of Santa Ana; it's o£ ficers, 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 CITSAAA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Community Development Agency Attn:Frank Hernandez AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza Santa Ana, CA 92702 © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD