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ILLFOU -001 CHAN
<br />�--� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE
<br />'
<br />171181216/201YYYYl
<br />414
<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(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 (888) 825.4322
<br />NAME:C Andrea Chastain
<br />Bowarmaster B Associates
<br />PHONE LL FA ..
<br />mC N 714- 733 -6208 nr No 714. 252 -8253
<br />P.O. Box 6026
<br />10605 Holder Street - Suite 350
<br />_
<br />Ao.Ress;achastIll bowermoster.com
<br />INSURERSAFFORDINGCOVERAGE_ NAICd�-
<br />Cypress, CA 90630
<br />wsuRERA;NonpraNts' Insurance Alliance of California,,!
<br />INSURED Illumination Foundation
<br />INSURERB;5tata Compensation Insurance Fund _
<br />INSURER CCU
<br />2691 Ritcher Avenue
<br />.Suite 107
<br />INSURER D ;
<br />Irvine, CA 92606-
<br />INS URERE:
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER;
<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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 7 H
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECr TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH PotJCIFS. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INeR -_ Z am P0'L1�V EFF pO8C EX __._...LIMITS .-,...
<br />T TYPE OFINFURANCE IwV POLICY NUMBER MIDpMYY MMIDD)YY% LIMITS
<br />GENERAL LIABILITY
<br />EACHOCCURRENCE 5 1,000,00_0
<br />A XICOMMERGIAL GENERAL Unewry
<br />X
<br />201324772NP0
<br />9115Y2013
<br />917512014
<br />_
<br />150:MAGEiO RENTE ➢'— -
<br />PREMISES (Ed oaurrsnce _ 5 500,000
<br />CLAIMS MADE nOCCUR
<br />MED ERR (Any ane porao9) S 20,000
<br />PERSONAL & AOV INJURY & 1,000,000
<br />_I
<br />GENERALAGOREGATE_ S 3,000,00
<br />— .___.._..__........_..— .__..
<br />GEN'L AGGREG_AT_ E LIMIT APPLIES PER
<br />_
<br />DU
<br />PROCTS:COMPlOP AUG � S 3,000,000
<br />1 PRG
<br />..___— _
<br />X POLICY ! LED
<br />AU MI LIABILITY
<br />00MVINED SINGLE LIMIT
<br />eeEd.n + }�s 1,000,000
<br />n0DiLVINduav(Prpeaon) s
<br />A X ANY AUTO
<br />201324712NPO
<br />9/1612013
<br />9/1512014
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />a001LY INJURY {par xogoaty S
<br />NOWOrXNED
<br />HIRED.AUT0.4
<br />- rTf'Gi DIRT!- DAgAUC -v.... j S
<br />i5
<br />...
<br />UMBRELLA LIAB
<br />OCCUR
<br />__—._
<br />EACH_ OCCURRENCE
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />AGGREGATE 5` _
<br />OED RETENTION 5
<br />5
<br />WORKERS COMPENSATION
<br />WCSTATU. IOTi11
<br />T413YUha 5�
<br />ANDEMPLOYERa UV4B1U1Y
<br />B fANY P.ROPRI ToR, ARTNER+E%EOUTN£ YrN
<br />90409502014
<br />111/2014
<br />"11312015
<br />R,L__
<br />EL.EACBACClDENT S 1,000,000
<br />OPRCERAIRABER E %CLUDED?
<br />(MmAlmurytoNRI
<br />NiA
<br />I— —
<br />EL, DISEASE - EA EMPLOYED S___ 1000,00
<br />i i(yyes de T'819 under
<br />PESCRIPTION QF OPERATIONS bolow
<br />•-^-. ...♦ 8 .. _..._0_
<br />E.L. DISEASE - PODGY LIMIT 18 1,000,00
<br />A (Professional Liability
<br />201324712NPO
<br />911512013
<br />911512014
<br />OccurrencelAggregatel ,000,0001$3,000,000
<br />A Improper Sexual Conduct
<br />201324712NPO
<br />9115/2013
<br />i
<br />911512014
<br />Occurrence /Aggregate $250,0001$250,000
<br />L
<br />_
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES hvidne AGGRO 191, Additional Remarks Schedule, H mom space is maeired)
<br />RE: HPRP Contract #A-2009-1137 Homeless Prevention and A- 2005.137A Rapid Re- Housing
<br />City of Santa Ana, their officers, officials, employees, agents and volunteers are Additional Insureds per attached #CG2026 endorsement with
<br />primary wording per policy form CGOOD10798.
<br />A
<br />Z $C?rTTm
<br />City of Santa Ana
<br />20 Civic Center Plaza, M -25
<br />Santa Ana, CA 92701-
<br />,^,,:.... cnPv
<br />SHOULD ANY OF THE ABOVE DESCRIBED N9i4 ����IkAMt E�Ia"Abh'tED BEFORE
<br />THE EXPIRATION DATE THEREOF, N bE" WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />A ,_.
<br />
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