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<br />A�y CERTIFICATE OF LIABILITY INSURANCE QATE (MM/QQIYYYV)
<br />ko�_ _ 117/2015
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TW CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIV��EEL�LQQY� ��Ojj F,RM��ANSiEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE kFFORDED BY THE POLICIES
<br />SOR PRODUCER, O R,IANO'Ti1BldE'RTJFJGA �. CONSTITUTE A CONTRACT BETWEEN THE ISSUI AG INSURER(S), AUTHORIZED
<br />REPRESENTATIVELO THIS
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policypes) must be endorsed. If BURRO 3ATI0111 IS WAIVED, subject to
<br />the terms and conditions of the polica,Ic' "J,oliairiTr require an endorsement. A statement on this certifier to duet! not confer rights to the
<br />certificate holder In lieu of such endo, J 7 rt
<br />pp—
<br />PRODUCER LIC@nse # 0725293 .,• I I t - u
<br />Arthur J. Gallagher R Co. Insurance Brokers of CA., Inc.
<br />505 N Brand Blvd SURE 800
<br />Glendale, CA 91263
<br />CONTACT
<br />NAME:
<br />_
<br />PHONE 818 539.2300 l' TIIC 818 539.2301
<br />A C No San, ( ) _ _, 1 No :
<br />ADDRESS:
<br />INRUIRIFFY&I AFFORDING COVET %GE NAIC#
<br />A
<br />_
<br />INSURER A; Nonprofits' Insurance Ailla!'.Ce erf I'A
<br />INSURED
<br />INSURER S:
<br />INSURER C ;
<br />Special Service for Groups
<br />EACH OCC! RRENCE. $ 1,000,000
<br />905 E. 8th St.
<br />INSURER D:
<br />INSURER E :
<br />Los Angeles, CA 90021
<br />INSURER F :
<br />01(01/2015
<br />COVERAGES CERTIFICATE NUMBER: REVISIOI'L NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED. BELOW HAVE BEEN.ISSUED TO THE INSURED NAME- ABC'VII: FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, PERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUME'ITWIFF RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREI I IS SIJHJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />[NSR
<br />LTR
<br />TYPE OF INSURANCE
<br />LS
<br />R
<br />POLICY NUMBER
<br />POLICY EF
<br />MOLDDYEX�
<br />LIMITS
<br />— —
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCC! RRENCE. $ 1,000,000
<br />CLAIMS -MADE ®OCCUR
<br />X
<br />2015'11247NP0
<br />01(01/2015
<br />01/01/2018
<br />DAMAGET
<br />PREMISES 'ceocclpnce $ 500,000
<br />MED EXP(ny one person $ 20,000
<br />X Sexual Misconduct
<br />X no deductible
<br />PERSONAL & ADV IN .JURY $ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL, GGREGfi rE $ 3,000,00
<br />PRODUCT::-CON!PP7P AGG $ 3,000,000
<br />❑ PRO-
<br />POLICY JECT n LOC
<br />L�
<br />OTHER:
<br />SEXUAL AISCONDU $ 1,000,000
<br />AUTOMOBILE LIABILITY
<br />COMBINE[ 3INGLI=LIMIT
<br />Ea aocider $ 1,000,00Y
<br />_
<br />BODILY IN.! 1RY(I'ar Terson) $
<br />A
<br />X ANYAUTO
<br />201611247NPO
<br />01/01/2015
<br />01/0112016
<br />BODILY IN, IRY(Far accident) $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS AUTOSWNED
<br />Per agAd"D)AMA(3E. $
<br />(Per accirle
<br />no dedu. table $
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCC IRRENCI! $ 5,000,00
<br />AGGREGA E $ 5,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />2015.11247-UMB
<br />01/01/2015
<br />01101/2016
<br />DED X RETENTION10,000
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' IJASIUTY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />$
<br />PER I OTH-
<br />STAT TE 1 ER
<br />._.
<br />E.L. EACH CCIDI:N'I' $
<br />-- `
<br />E.L. DISEA: E_EP EMPLOYEE $
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />E.L. DISEA-E^POLIIYLIMIT $
<br />if be
<br />OESCRIPTI be un OPERATIONS below
<br />A
<br />Professional Liab
<br />201511247NPO
<br />01/0112015
<br />01/01/2016
<br />Per CDC rrenec 1,000,000
<br />A
<br />Professional Liab
<br />201511247NPO
<br />01101/2015
<br />01/01/2016
<br />Aggregz a 3,000,000
<br />T
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />City of Santa Ana its officers, employees, agents, volunteers, and representatives are named additional insured with respi ;t to [bet operations of the named
<br />Insured. Such insurance is Primary and Non -Contributory. III
<br />City of Santa Ana
<br />Santa Ana Workforce Investment Board
<br />1000 E. Santa Ana Blvd., Suite 200
<br />Santa Ana, CA 92701
<br />ACORD 25 (2014/01)
<br />SHOULD ANY OF THE ABOVE DESCRIBE['. POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, WTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVW ONS.
<br />AUTH//�O�RIZED REPRESENTATIVE_ --O}
<br />(D 1988-2014 ACORD CORP )RA4'I ON. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />000264
<br />
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