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OP ID: AL
<br />:- � CERTIFICATE OF LIABILITY INSURANCE
<br />DAT02117/1155 V)
<br />02/17
<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 626-943.2200
<br />Narver Insurance
<br />641 W. Las Tunas Drive 626-299-1010
<br />PO Box 1509
<br />San Gabriel, CA 91776
<br />Robert Molinaro
<br />CONrncr Angola Love
<br />NAME:
<br />PHONE E,,b 626-943-2225 NAXNe; 626.299.1010
<br />EMAIL alove/,anarver.com
<br />ADDRESS: @narver.com
<br />CUSTOMER ID #: KIDWO.1
<br />INSURERS AFFORDING COVERAGE NAIL#
<br />INSURED Kid Works Community Development
<br />INSURER A: Philadelphia Indemnity Ins. 16058
<br />Corporation
<br />INSURER B ; Everest National Insurance 10120
<br />1902 West Chestnut Avenue
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />Santa Ana, CA 92703-4304
<br />INSURER C
<br />PHPK1284134
<br />01/07/15
<br />INSURER D
<br />INSURER E :
<br />MED EXP (Anyone person) $ 5,000
<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 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 />/NSR
<br />OF INSURANCE
<br />ADDL�TYPE
<br />5 D
<br />POLICVNUMBER
<br />POLICY EFF
<br />Y EXPR
<br />MMIDDi
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />PHPK1284134
<br />01/07/15
<br />01/07/16
<br />PREMISES Ea occurrence $ 100,000
<br />MED EXP (Anyone person) $ 5,000
<br />PERSONAL B ADV INJURY $ 1,000,000
<br />GENERALAGGREGATE $ 3,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $ 3,000,000
<br />X POLICY PE� LOC
<br />$
<br />X
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />PHPK1284134
<br />07/07/15
<br />07/07/16
<br />COMBINED SINGLE LIMIT $ 1,000,000
<br />(Ea accident)
<br />BODILY INJURY (Per person) $
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Per accident) $
<br />A
<br />X
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />PHPK1284134
<br />01/07/15
<br />01/07/16
<br />PROPERTY DAMAGE
<br />(Peracciden0 $
<br />A
<br />X
<br />NON-OWNEDAUTOS
<br />PHPK1284134
<br />01/07/15
<br />01/07/16
<br />$
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 1,000,000
<br />AGGREGATE $ 1,000,000
<br />A
<br />EXCESS LIAR
<br />CIAIMS�MADE
<br />PHU6487501
<br />01/07/15
<br />01/07/16
<br />DEDUCTIBLE
<br />$
<br />$
<br />RETENTION $ 10,000
<br />B
<br />WORKERS COMPENSATIONX
<br />AND EMPLOYERS'LIABILITV
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />5900001267
<br />02/01/15
<br />02101/16
<br />WC STATU- OTH
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E. L. DISEASE EA EMPLOYEE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />A
<br />Professional
<br />PHPK1284134
<br />01/07/15
<br />01/07/16
<br />Per Claim 1,000,000
<br />Liability
<br />Aggregate 3,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is read Intl)
<br />Subject to all policy terms conditions and exclusions. 10 days notice of
<br />cancellation in the event oi non-payment of premium.
<br />City of Santa Ana named as additional insured yerLQspects General Liability
<br />Form# CG 20 26 04 13 per written contract or r
<br />CERTIFICATE HOLDER �P / CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana w JD$t%
<br />Sall
<br />SHOULD
<br />IYIE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City A
<br />LI CORDANCE WITH THE POLICY PROVISIONS,
<br />Attn: Risk Management Se j®T Assistant
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92704
<br />ACORD 25 (2009109)
<br />©1988.2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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