ORANGE COUNTY ASIAN & PACIFIC ISLANDER COMMUNITY ALLIANCE - 2014

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AC`��QD C7" CERTIFICATE OF LIABILITY INSURANCE CATS [MMlDDIYYYY) F10/02/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES )W. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED n" RESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, If SUBROGATION IS WAIVED, sUhject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Willis Insurance Services of California, Inc. CONTACT NAME: PHONE FAX �(8".No.Ext)•1-877-945-7370 AIC,No):1-800-467-2376 c/o 26 Century Blvd V.O. Box 305141 Nashville, TN 372305191 _ E-MAIL ADDRESS: certificates@willis.com EACH OCCURRENCE 5 INSURERS) AFFORDING COVERAGE NAIL p iNSURERA:XL SIpecialty Insurance Com an I 37805_ 1NSUREDSpecial Service for Groups INSURER B: INSURER C: 905 E. 8th St Los Angeles, CA 90021 AGGREGATE LIMIT APPLIES PER; POLICY JE � E LOC OTHER: GENERAL AGGREGATE $ ^ INSURER D: INSURER E INSURER F: LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COVERAGES CERTIFICATE NUMBER:WS92515 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRTYPE LTR OF INSURANCE ADDL D SUBR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS _ COMMERCIAL GENERAL UAS)LITY CLAIMS-MADE1:1 OCCUR EACH OCCURRENCE 5 DAMAGE TO RENTED PREMISES Ea Occurrence 5 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER; POLICY JE � E LOC OTHER: GENERAL AGGREGATE $ ^ PRODUCTS - COMP/OP AGG $ $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per aGG[dent UMBRELLA LIAROCCUR EXCESS LIAB HCLAIMS-MADE EACH OCCURRENCE II AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION - AND EMPLOYERS' LIABILITY Y! N ANY PROPRIETORIPARTNERlEXEC12TIVE OFFICERIMEMBEREXCLUDED? (M andatory in NH) If yes, describe under DESCRIPTION OF OPERATICNS below NIA RWD500029503 10/01/2014 10/01/2015 x STATUTE ETH E,LEACHACCIDENT 5 1, 000, 000 _ _ E,L.DISEASE - EA EMPLOYEE $ 1,000,ODO E L DISEASE - POLICY LIMfT $ 1, 004, 000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (AGO RD 101, Additional Remarks Schad uia, maybe attach ad if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE W{TH THE POLICY PROVISIONS. City of Santa Ana, its officers employees, agents, volunteers, and representatives AUTHORIZED REPRESENTATIVE Santa Ana Workforce Investment Board q 1000 E. Santa Ana Blvd., Suite 200 I� /' �r Fanta Ana, CA 92701 f ' / \ AGORD 25 (2014101) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name aril logo are registered marks of ACORD SR ID:7295532 RATIH:A rr7, '.I - gF.9F'