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ORANCNT-01 VRXKUMAR2 <br />If- CERTIFICATE 4F LIABILITY INSURANCE <br />DATE (MMfDDIYYYY) <br />F1012412014 <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 />1 -OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />_PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 License # 0726293 <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 />PHDNE (818) 539-2300 AX No : ($ [ 8) 539-2301 <br />Arc No Ext:(AJC <br />ADDRIESS: <br />INSURER(S) AFFORDING COVERAGE N= 4 <br />INSURER A; Great American Insurance Company 116691 <br />INSURED <br />INSURER B : <br />INSURER C <br />Orange County Asian & Pacific Islander Community Alliance <br />INSURER D <br />12900 Garden Grove Blvd #214A <br />INSUReR E <br />Garden Grove, CA 92843 <br />INSURER F: <br />X Sox Abuse $1 MI$2M <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OE..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 I TYPE OF INSURANCE <br />LFR <br />D <br />SO <br />WVO <br />POLICY NUMBER <br />POLICY EFF <br />MMIDWYYYY <br />POLICY EXP <br />MMIDDIYYYY <br />LIMITS <br />A X COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,000 <br />CLAIMS -MADE OCCUR <br />X <br />PAC 033-09.78.02 <br />10!1512014 <br />10!15!2015 <br />PREMISES Ea oDAMAGE -ccurr1 EL)ence $ 100,000 <br />MED EXP (Any one person) $ 5,000, <br />X Sox Abuse $1 MI$2M <br />X Prof Liab $1 MOM <br />PERSONAL &ADV INJURY $ 1,000,000. <br />GEN'L AGGREGATE LIMIT APPLIES PER; <br />GENERAL AGGREGATE $ 2,000,000' <br />POLICY PEO LOC. <br />PRODUCTS-COMPIOPAGG $ 2,000,000' <br />Deductible $ 01 <br />OTHER: <br />- <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT $ <br />Ea accident <br />BODILY INJURY (Per person) $ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS ALITOS <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />BODILY INJURY (Per accident) $ <br />PROPERTY DAMAGE $ <br />Per accident <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE S <br />AGGREGATE $ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDE{)? <br />NIA <br />PER I STATUTE ORH <br />E.L. EACH ACCIDENT $ <br />(Mandatory in NH) <br />E.L. DfSEASE - EA EMPLOYEE! $ <br />if yes, describe under <br />DESCRIPTION OF OPE RATIONO balo,.v <br />E.L. DISEASE , POLICY LI".'.IT $ <br />A <br />Employee Dishonesty <br />PAC 033-09.78-02 <br />90115!2014 <br />1011512015 <br />Deductible: $1000 50,000 <br />A <br />Forgery & Alteration <br />PAC 033.09.76-02 <br />10!15!2014 <br />10115/2015 <br />Deductible: $1,000 50,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <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 />LAJ <br />CERTIFICATE HOLDER CANCELLATION <br />—9 <br />�s <br />ti <br />1N <br />ACORD 25 (2014101) <br />©1988-2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />000019 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Cit of Santa Ana <br />City <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />1000 E. Santa Ana Blvd. Suite 200 <br />Santa Ana, CA 92701 <br />AUTHORIZE[] REPRESENTATIVE <br />ACORD 25 (2014101) <br />©1988-2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />000019 <br />