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OP ID: RY
<br />Ailco�.° CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 01/2DD/VYVY)
<br />01/24114
<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(ies) 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 />Global Program Managers
<br />P.O. Box 7119
<br />NAMEACT Ran Wood
<br />PHONE FAX
<br />Arc N Ea . 626. 943 -2213 ac Nei 626. 299 -1010
<br />Capistrano Beach, CA 92624
<br />Wesley G. Hampton
<br />MAIL rwood@narver.com
<br />PRODUCER
<br />USTOMER ID N: KIDWO -1
<br />INSURERS AFFORDING COVERAGE
<br />NAIC $
<br />INSURED Kid Works Community Development
<br />INSURER A; Philadelphia Indemnity lnsuran
<br />18056
<br />1902 W. Chestnut Avenue
<br />Santa Ana, CA 92703 -4304
<br />INSURER B: Everest National Insurance Co.
<br />1 0120
<br />INSURER C
<br />INSURER D:
<br />INSURER E,
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS 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 />ILTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INES
<br />UBR
<br />POLICYNUMBER
<br />POLICY EFF
<br />MM /DDNYVV
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />-MM
<br />EACH OCCURRENCE
<br />$ 1,000,006
<br />•
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />PHPKII20959
<br />01/07/14
<br />01/07115
<br />DAMA ET
<br />PREMISES to occurrence
<br />$ 10,000
<br />MED EXP(Any one person)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GENERALAGGREGATE
<br />$ 3,000,000
<br />CENT AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP /OP AGG
<br />$ 3,000,000
<br />X POLICY PRO-
<br />F LOC
<br />JECT 17
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1,000,000
<br />ANYAUTO
<br />BODILY INJURY (Per person)
<br />$
<br />ALLOWNEO AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />•
<br />X
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />PHPK1120959
<br />01107114
<br />01107115
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />•
<br />X
<br />NON -OWNED AUTOS
<br />PHPK1120959
<br />01/07114
<br />01107115
<br />$
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />•
<br />EXCESS LIVE
<br />CLAIMS -MADE
<br />PHUB446716
<br />01107/14
<br />01107115
<br />DEDUCTIBLE
<br />$
<br />$
<br />X
<br />I RETENTION $ 10,000
<br />•
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY
<br />ANY PROPRIETOR /PARTNER/EXECUTIVE YIN
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If Yes describe under
<br />DE SC RIPTION OF OPERATIONS below
<br />NIA
<br />CA10001753141
<br />02101114
<br />02101115
<br />X WC STATU OTH-
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E. L. DISEASE EA EMPLOYEE
<br />$ 1,000,000
<br />E.L DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />•
<br />Professional Liab
<br />PHPKI120959
<br />01107114
<br />01107/15
<br />Each 1,000,000
<br />Aggregate 3,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<br />RE: Nutrition Awareness Conference - February 1, 2014 from 8:OOam - 4:00pm.
<br />The City of Santa Ana, its officers, agents, employees and volunteers are
<br />named as Additional Insured in regards to the attached General Liability
<br />Form. Thirty (30) days advance written notice of cancellation. This
<br />insurance is primary and non - contributory with respect to any other
<br />CERTIFICATE HOLDER t 1-J- `L)VfjD AS TO FOR CANCELLATION
<br />SANTAAN
<br />City of Santa Arty- °(�f" <�-^-'^" 13
<br />y i.Blll'O utl' $)ICCC)
<br />20 Civic Center Plaza
<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 />Assistant Santa Ana, CA 92701 EASS1Stant City Attorney
<br />AUTHORIZED REPRESENTATIVE
<br />©1988 -2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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