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ORANCNT- <br />0'1 GVILLACIS <br />�cra n° -- -_- --- <br />CERTIFICATE OF LIABILITY INSURANCE DA11/13/2013 Y) <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 IPISURED 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 - CONTACT <br />NAME <br />California -PHONE -... ...__ ...... <br />1C,N FAX <br />PO Box 742886 E-MAIL E40 __ __,.,. I fAlc NO)_,_ <br />Los Angeles, CA 90074.2886 E-MAIL <br />ADDRESS. <br />INSUrED <br />Orange County Asian & Pacific Islander Community Alliance <br />12900 Garden Grove Blvd #214A <br />Garden Grove, CA 92843 <br />A i Great American <br />DVERAGES 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 CONTRACTOR 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 />q <br />TYPE OFINSURANCE SUER <br />POLICY EFF- POLICY EXP <br />.... .......I ..___- ..._.. INSR I.y9yDl POLICY NUMBER (MMIDDIVYYV) fMMIDDIYYYYf LIMITS <br />GENERAL LIABILITY _._�' -... ..) ...._ —.. .... —I_ _..... ____ <br />A X COMMERCIAL GENERAL LIABILITY 1 X PAC033097801 10/15/2013 10/1512014 DAMAGE I"61TKN- 5'FC1' - <br />;- r PftEMISESL occurrence) $ <br />CLAIMS MADE IX J OCCUR MED EXP(Any onepe,orm $ <br />X C Prof Liabdlty Inc/ - -- --- <br />ff S- - -- PERSONAL &AT INJURY $ <br />X ex Abuse Included " " - -- - -- <br />- - - - -- - -- -..... GENERAL AGGREGATE $ <br />I_GENLAGGREGATE LIMIT APPLIES PFR' PRODUCTS - COMP /OP AGG $ <br />POLICY_ -- <br />_ ._- JECT_ LOU _- _. -.... ;_._.. _ I' <br />. _ — __ - _......_.__ ..._..- T <br />AUTOMOBILE LIABILITY j GOMBINEp SINGLE LIMIT <br />_a accdent) <br />A _ IANYAUTO __ PAC033097801 10/1512013 10/15!2014 BODILY INJURY (Per person) $ <br />ALL OWNED SCHEDULED ('- <br />AUTOS — (AUTOS �Y wH BODILY INJURY (Per accident) $ <br />X -HIRED AUTOS �X NON-OWNED V $W n1�j .� PROPERTY DAMAGE $ P-1 )WO -_ ylll RRR �•+ jPER ACCIDENTL __I_ <br />UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br />EXCESS LIAB - <br />_. CLAIMS MAO_E -...- S CORGP` li AGGREGATE _ �$ <br />OED RETENTION$ _ _ '_°° LISA `I AtiOr�teV <br />li WODRKERS COMPENSATION 61StcC �{J $ <br />;AN EMP LOVERS LIABILITY yIN j A5 n TORY Lhf_ITS OER <br />ANYCER /MEETORIPARTNDED' Ct1TIVE ! ) Iy <br />(MandaWMEn AD)EXCLUDED? t NIA °IL, EL EACH ACCIDENT Ig <br />• ((Mandatory NH) EL DISEASE - EA EMPLOYE $ <br />Dyes deec Ib under ._ <br />DESCRIPTION OF OPERATIONS belo <br />EL DISEASE - POLICY LIMIT,$ <br />f .. <br />Employee Dishonesty ! fPAC033097801 10115(20131( 10115 12014 tDeducCilble: $1,000 <br />• 'Forgery & Alteration jPAC033097801 10(1512013 10115 /2014 jDeductible: $1,000 <br />DESCRIPTION OF OPERATIONS (LOCATIONS (VEHICLES (Attach ACORD 107, Additional Remarks Echetlule If more space Is qulred) <br />OCAPICA 12900 Garden Grove Blvd Suites: 210A, 214A, 220A, 222B, 225B and 224B, Garden Grove, CA 92843 <br />City of Santa Ana, its officers, employees, agents, volunteers, and representatives are named additional insured with respect to the operations of the named <br />insured. Such insurance is Primary and Non - Contributory per endorsement attached CG 20 26 07 04. <br />CERTIFICATE HOLDER <br />City of Santa Ana <br />1000 E. Santa Ana Blvd. Suite 200 <br />Santa Ana, CA 92701 <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 />J1�? <br />©1988 -2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name anM 9 AiP3 marks of ACORD <br />