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<br />ORANCOU -19 WXKUMAR3
<br />'%11I.I CERTIFICATE OF LIABILITY INSURANCE
<br />°ATE1112014 Y'
<br />2/11/2014
<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 FAx
<br />Arc No E.1), (818) 539 -2300 AIC,No) (818) 539 -2301
<br />EMAIL
<br />ADORES&
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC q
<br />INSURER A: Great American Insurance Company
<br />INSURERS NonProfltS United
<br />15691
<br />INSURED
<br />INSURER C:
<br />A
<br />Orange County Conservation Corps
<br />1853 N. Raymond Ave.
<br />Anaheim, CA 92801
<br />INSURER D:
<br />PAC5154680 -08
<br />INSURER E
<br />7/20/2014
<br />INSURER F
<br />$ 100,000
<br />MED EXP(Any one person)
<br />COVERAGES CERTIFICATE NUMBER: RpvISInN NIIMRRR.
<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 MAYBE 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 />[NSR
<br />Me
<br />POLICY NUMBER
<br />MMOOOIYYYVY )
<br />(MM01L0'CDyN"YXY`YI .
<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 />PAC5154680 -08
<br />7/20/2013
<br />7/20/2014
<br />A
<br />PREMISES Ea occurrence)
<br />$ 100,000
<br />MED EXP(Any one person)
<br />$ 5,000
<br />X Professional $1 M
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />X
<br />Sexual Abuse $1 M
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />PRODUCTS - COMP /OP AGO
<br />$ 3,000,000
<br />POLCY PEA LOG
<br />$
<br />B
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANYAUTO
<br />1888
<br />7/1/2013
<br />7/1/2014
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />5,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />A O SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY Per accident
<br />( )
<br />$
<br />_ X
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DA GE
<br />PER ACCIDENT MA
<br />$
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />UMB560379506
<br />8/1712013
<br />811712014
<br />AGGREGATE
<br />$ 1,000,000
<br />DED I X I RETENTION$ 10,000
<br />1 $
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICEWMEMBER EXCLUDED?
<br />NIA
<br />NPU -WCG 001 -2014
<br />1/112014
<br />1/1/2015
<br />WC STATU- H.
<br />OT
<br />TORY LIMITS ER
<br />E.L. EACHACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />1-7
<br />DESCRIPTION CF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is 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 />�TOR�
<br />CERTIFICATE HOLDER
<br />CANCELLATION -.itv
<br />Ait0YnP7
<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 />The City of Santa Ana
<br />20 Civic Center Plaza
<br />_ ISanta Ana CA 92702 ___
<br />n © 1988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name an2l5A,"6e,cI marks of ACORD
<br />EXHIBIT I
<br />
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