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<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MMOl
<br />_j 913/2015
<br />7_HI5C_E_R1'1_F1CA7E IS ISSUEDASA —MAT—TE—ROF—INFOR-Mi—ATION 0N1.,YA`ND CONFERS _IVC) R1GHTSUPO'NTHE C_E_RTI FICA _1E_HOLDER__'_'
<br />THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTENT) OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUREll AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />TNI`PC)kf_ANT:_If the —certificate —holder _is an 7ADDITIO—NAIL 1!—N'S—I1IRE—D,t—lie—poli—cy(—i"es)—must bp endorsed. _1fSU_1B_R_0_GA_flON1S WAIVED, _subjectto'
<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 UV f a., I
<br />N AA Jenny Kim
<br />Arthur J. Gallagher & Co. PHONE 818 539-23010 FAX 818,,539-2301
<br />Insurance Brokers of CA, Inc. LIC # 0726293 JAIC, No, EXtY . ..... . . . ..... ..........
<br />E-MAIL
<br />505 N Brand Blvd, Suite 600 ADDRES, Jenny1Kirn@)ajg,com
<br />Glendale CA 91203 INSURERTS) AFFORDING COVERAGE i MAIC
<br />INSURER A:Great American Insurance COrnpany
<br />. . ...... .... . . . .
<br />INSURED
<br />INSURER 9:
<br />Orange COUnty Asian & Pacific Islander Community INSURER C_:
<br />Alliance
<br />12900 Garden Grove Blvd #214A INSURER D:
<br />Garden Grove CA 92843 INSURER E:
<br />COVERAGES CERTIFICATE NUMBER: 1425255935 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT TF1E PCI ICIES OF INSURANCE 17—F) 13l HAVE BEEN ISSUED' TO 1HE INSURE[) NAMED ABOVE FOR THE POLTEY -PERIOCT
<br />INDICATE[), NOTWITI [STANDING ANY REQUIREMENT, TERM OR CONDI-PION OF ANY CON -I RACri. OR OTHER D�)CUMEN r wi t I RESPECT TO WHICII I THIS
<br />CERFIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INI.-A)RIANCE AFFORDED BY THE POLICIES DIESCRGED HEREIN IS SUBJLC_F '10 ALL THE TERMS,
<br />EXCLUSIONS AND CONDI Fri ONS OF SUCH POLICIES. LIMITS S1 IOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />INR ADDLSUBRf . P . 0 - U . C . Y , EFF 1 11 P 1 0 L I` C_ Y EXP
<br />LTR TYPE OF INSURANCE POLICY NUMBER MfGDVYjyjLL. LIMITS
<br />A X COMNIERCaAl_ GENERAL LIABILITY Y PAC 033-09-7l :1005/20,15 1011512016 J,-ACI1 OCCURRENCE$100
<br />I � 0,000
<br />l FORENJO)
<br />CIAll x OCCUR
<br />PREMISES (Ea ppuirrOlco) 1 $100,000
<br />X $e&rafUaAbuse l'IM12M. MLD EXIl (Any One pptsonY $5,000
<br />X Pb & ADV INJURY $11000XO
<br />CEN V.. AGGREGAl FE LIMIT APPLIES PER:
<br />GENERALPERSONAL AGGREGATE $2,000,000
<br />PRO
<br />POI ICY JLC I LOC PRODUC jr,- r C0r0PjOP AGO s 2,000,0010
<br />OTHER
<br />so
<br />ArYTOMOBILELIABIll io/.I@201f� ioli,i ff�PAC 033-09- /9 03Aent) 51,000,4100
<br />ANY AD FO BODILY INJURY (Pyr $
<br />ALL OWNE-D SCHEDULED PODLY INJURY (Nee accidollir) $
<br />AU FOS AUTOS
<br />X NONOWNEDI'Wr)PERTY DAMAGE—
<br />HIRED AUTOS X AUTO S
<br />(Per accidert)
<br />DeduclRk $0
<br />.............
<br />UMBRELLA LIABOCCUR I OCCURRENCE $
<br />EX,CES
<br />S LA6 CLAIl AGGREGATE R.
<br />DIED RETENTIC)N
<br />$
<br />WORKERS COMPENSATION PE l
<br />S-TARTTE, 1-' R
<br />AND EMPLOYERS" Il YIN
<br />.V
<br />ANY PROPRlFIC�R'PAFeINI�rP/F�XE(UlI E EACH ACCIT)ENT $
<br />OrFICEWMEMBER EXCLUDED'? IN
<br />(Mandatory in NIT)
<br />L L, DISEASE - EA EMPLOYEE: $
<br />E resC
<br />S. describe undw
<br />D -
<br />- RIPI loN OF OPERATIONS below
<br />F L DISEASE POI ICY LIMIJ
<br />A PAC 033-09-78-03 100512015 "1011512016 6 DRducl $1,000 50,000
<br />A Forgery & Afteration PAC 033-09-78-03 101,15/20,15 10115,20'16 Dedlrctible. $1,000 50,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS IVEHICLES (ACORD 101, Additional R(nnarks Scl may be auachad if rnore space Is mquirod)
<br />Clty of Santa Ana, its officers ornployees, agents, volunteers, and representatives are named additional insured with respect to the
<br />operations of the named insl Such insurance is Primary and Non -Contributory por endorsement attached CG 20 26 07 04
<br />S,
<br />CERTIFICATE F[OLDER CANCELLATION
<br />City of Santa Ana
<br />1000 E. Santa Ana Blvd, Suite 200
<br />Santa Ana CA 92701 USA AUTPIORazEr
<br />-1 RESENTATNE
<br />eo
<br />1,988.2014 ACORD CORPORATION, All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAN( CLL[ BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH"ITIE POLICY PROVISIONS.
<br />All 25 (21(314101)
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