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ORANCOU-07 RKUMAR
<br />'$_rz CERTIFICATE OF LIABILITY INSURANCE aAt,isiz nYYYi
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<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 WAIVEp, 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 CONTACT
<br />L,r,apman
<br />mune .1 {628) A45 -843f TAA 1 {Fi24) 405-05E
<br />Arc No ExF�_ {AIc Nat:
<br />a Division of Arthur J. GaHaghar & Co,
<br />GENERAL LIAWLITY
<br />Insurance Brokers of California, Inc.
<br />E"MAIL
<br />ADDRESS:
<br />A X COM v111
<br />ucRCIALGENERAL ABILITY X PAC5154680.07 772012012 712012013
<br />PO Box 5455
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<br />Pasadena, GA 91117.0455
<br />INSURER{S) AFFORDING COVERAGE
<br />NAiO#
<br />�_.._.
<br />INSURER A: Great American Ins Urance Company
<br />16681
<br />INSURED
<br />_....._...Un.
<br />INSURER B:NOf1PCOPliS UllltBCl
<br />....T_
<br />Orange County Conservation Corps
<br />INSURER C:
<br />GENT AOD'HF.GATE LIMIT APPLIES PER:
<br />1853 N. Raymond Ave.
<br />INSURER O:
<br />POLIC OG
<br />�Y ...L.......� PEC
<br />-"' __�..._.-..
<br />Anaheim, CA 92801
<br />.._.�.�.._.
<br />AUTOMOBRE LIABILITY
<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 CONTRACTOROTHER DOCUMENTWITH RESPECT TOWHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ISSUBJECT TOALLTHETERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INNER ADD, SUB- POLICY EFF j7 POLICY EXP
<br />LTR TYPE OF INSURANCE INSR WVQPOLICY NUMBERMMIDDrI Yj lyM1§MtOtNYYYY
<br />- LIMITS
<br />GENERAL LIAWLITY
<br />EACH OCCURRENCE S
<br />1,000,00{}I
<br />A X COM v111
<br />ucRCIALGENERAL ABILITY X PAC5154680.07 772012012 712012013
<br />OAMAG� 10 PREMISESEaocevrrencej_
<br />al
<br />CLAINIS-MADE71
<br />OCCUR
<br />MED EXP (Any one person)
<br />X Professional$1M
<br />PERSOPIAL&BUY INJURY S
<br />1,000,004
<br />X Abuse $1M
<br />GENERAL AGGREGATE S
<br />3,000,000
<br />GENT AOD'HF.GATE LIMIT APPLIES PER:
<br />PRODUCTS - COMPIOP AGO S
<br />3,400,000
<br />POLIC OG
<br />�Y ...L.......� PEC
<br />-"' __�..._.-..
<br />_._._
<br />S
<br />.._.�.�.._.
<br />AUTOMOBRE LIABILITY
<br />00 al dd,tl SINGLE LIMIT
<br />$,000,000
<br />B X ANY AUTO 1888 71112013 711/2014
<br />BODILY INJURY (Perperon) S
<br />ALL OWNED SCHEDULED-"
<br />AUTOS AUTOS
<br />BODILY INJURY(PereCCld.rc S
<br />X X NONOWNEDPROPERTY
<br />DAMAGE S
<br />HIRFOAUTOS AUTOS
<br />Per accidenfl
<br />f— UMBRELLA LIAB OCCtiR �_ ._.....
<br />EACH OCCURRENCE
<br />1,000,040
<br />,A EXCESS URe cUSlrts-MADE UM 8560379505 811712012 8117/2013
<br />AGGREGATE s
<br />Oen XJI RETENTION S14,444 _
<br />��
<br />110001464 E
<br />1,000,044
<br />WORKERS COMPENSATION
<br />X WC STATU- OTH
<br />AND EMPLOYERS' LIABILITYYIN
<br />TORY LIMITS
<br />B ANY PROPRIETowPARrNEwexecurlvE NPU•WCG 8012013 1/112013 11112014
<br />E.L. EACH ACCIDENT a
<br />1,040,000
<br />OFFICERIMEMUER EXCLUDED? � NIA
<br />(Mandatory In out
<br />E. L. DISEASE - EA EMPLOYEE S
<br />�..
<br />1,000,000
<br />If yes', tleecdhr under
<br />DESCRIPTION OF OPERANONSWe ,,
<br />E.LDISEASE-POLICYLI>dIT S
<br />1,400,000
<br />E5CRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additlorul Remarks Schedule, if more apeca Is mqulred)
<br />The City of Santa Ana, its officers, agents, employees and volunteers, and the State of California. its officers, employees,
<br />and volunteers are named
<br />additional
<br />insurediPunding Source with respect to the operations of the named insured per the attached CG 2026 endorsement.
<br />Such insurance is Primary
<br />and
<br />Non -Contributory. Workers Compensation coverage excluded, evidence only.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THF ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana, Workforce Investment Board THE EXPIRATION DATE THEREOF, NOTICE WILL BE: DELIVERED IN
<br />1000 E. Santa Ana Blvd., Ste. 200 ACCORDANCE WITH 7"HE POLICY PROVISIONS.
<br />Santa Ana, CA 92701 .. .-___.._......................
<br />AUTHORIZED REPRESENTATIVE
<br />fl1988-2010 ACORD CORPORATION. All rights reserved"
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
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