|
ORANCOU -19 VVXKUMAR3
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />14
<br />1 DATE 2/11/2011120Y4
<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 />Arthur J. Gallagher & Co. Insurance Brokers of CA., Inc.
<br />505 N Brand Blvd, Suite 600
<br />Glendale, CA 91203
<br />CONTACT
<br />NAME:
<br />PHONE PAX
<br />AID rvo Ext (81 8) g J 539.2300 A /C, No (818) 539 -2301
<br />E -MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVER AGE
<br />NAICH
<br />INSURER A: Great American Insurance Company
<br />16691
<br />INSURED -
<br />INSURER B: Non Profits United
<br />INSURER C:
<br />Orange County Conservation Corps
<br />INSURER D:
<br />1853 N. Raymond AVG.
<br />Anaheim, CA 92801
<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 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 />ILTR
<br />TYPE OF INSURANCE
<br />INSR
<br />S
<br />MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDM'YY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PREMISES Ea occurrence
<br />$ 10Q000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />X
<br />PACS154080-08
<br />7/20)2013
<br />712012014
<br />MED EXP (My one person)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />X Professional $1 M
<br />X
<br />Sexual Abuse $1M
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />GENL AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP /OP AGO
<br />$ 3,000,000
<br />POLICY PRO DEC
<br />JEC�
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 5,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />B
<br />X
<br />ANYAUTO
<br />1888
<br />71112013
<br />71112014
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (P., accident)
<br />$
<br />PROPERTY DAMAGE
<br />PER ACCT DENT
<br />_
<br />$
<br />X
<br />HIREDAUTOS Ix NON-OWNED
<br />AUTOS
<br />_
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1.000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />A
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />UMB560379506
<br />8117/2013
<br />8/1712014
<br />DED I X I RETENTION$ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETOR /PARTNERIEXECUTIVE
<br />OFFICERIMEMSER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />NPU -WCG 001 -2014
<br />1/1/2014
<br />11112015
<br />WC STATU- OTH -
<br />TORY LIMITS Eft
<br />EL EACH ACCIDENT
<br />It 1,000,000
<br />E.L. DISEASE -EA EMPLOYE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 141, Additional Remarks Schedule, If more space ie required)
<br />The City of Santa Ana its officers, employees, agents, volunteers and representatives are named additional insured with respect to the operations of the
<br />named insured. Endorsement to Follow. Workers Compensation coverage excluded, evidence only. Such insurance is Primary and Non - Contributory.
<br />m� 10 � 0,
<br />VLIT)
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DE$.b`PdFB'ED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />AUTHORIZED REPRESENTATIVE
<br />The City of Santa Ana
<br />20 Civic Center Plaza
<br />// ���
<br />/V°�'"%""%"`�f
<br />/Santa Ana, CA 92702.
<br />© 1988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name a2 E ted marks of ACORD
<br />
|