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OP ID: RY
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DAT 01124DIYYVY)
<br />01/24/14
<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 />No Ext : 626 - 943.2213 arc No): 626 - 299 -1010
<br />EMAIL rwood@narver.com
<br />co narver.com
<br />Capistrano Beach, CA 92624
<br />G. Hampton
<br />PRODUCER
<br />cu STOMERID :KIDWO °1
<br />INSURER($) AFFORDING COVERAGE
<br />NAICN
<br />INSURED KidWorks Community Development
<br />INSURER A: Philadelphia Indemnity lnsuran
<br />18058
<br />1902 W. Chestnut Avenue
<br />Santa Ana, CA 92703 -4304
<br />INSURER B; Everest National Insurance Co.
<br />10120
<br />INSURER C
<br />INSURER D
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSR
<br />SUER
<br />MD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDDIVYYY
<br />POLICY EXP
<br />MMIDDNM
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 1XI OCCUR
<br />X
<br />PHPK1120959
<br />01107114
<br />01/07115
<br />PREMISES Ea occurrence
<br />$ 10,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />GEN'L AGGREGATELIMIT APPLIES PER:
<br />PRODUCTS COMP /OPAGG
<br />$ 3,000,000
<br />X POLICY JE lJ LOD
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1,000,000
<br />ANV AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />ALLOWNED AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />A
<br />X
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />PHPK1120959
<br />01107114
<br />01107115
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />A
<br />X
<br />NON - OWNEDAUTOS
<br />PHPK1120959
<br />01107114
<br />01107115
<br />$
<br />$
<br />X
<br />UMBRELLA LIAB
<br />I X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />PHUB446716
<br />01107114
<br />01/07115
<br />DEDUCTIBLE
<br />$
<br />$
<br />X
<br />I RETENTION $ 10,000
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY
<br />ANY PROPRIETOR/PARTNERIEXECUTIVEY�
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />MIA
<br />CA10001753141
<br />02/01/14
<br />02101115
<br />X WC STATU- OTH
<br />TORYLIMITS ER
<br />-
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />if Dyes describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Professional Liab
<br />PHPK1120959
<br />01107114
<br />01/07115
<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: Youth Council Meeting - February 13, 2014 from 4:00 -8:30 pm.
<br />The City of Santa Ana, its officers, agents, employees and volunteer@@a
<br />named as Additional Insured in regards to the attached General Liabil'i
<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 1; '; - '~~ -,,. CANCELLATION Op 0
<br />, ANTAAN
<br />.-
<br />SC'a t V�
<br />SHOULD ANY OF THE ABOVE DESCRIBEDA �jE�S�SIIgqE CANCELL BEFORE
<br />City of Santa /[;.3
<br />20 Civic Cent Wife Ka
<br />Santa Ana, CA 92701
<br />THE EXPIRATION DATE THEREOF, NOTICE 11�U0 DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISION :y
<br />AUTHORIZED REPRESENTATIVE
<br />© 1988.2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
<br />
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