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Client #: 758615 THOMHOUS ACORDT. CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DD/YYYY) 1 0/0 912 01 4 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 BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. 1F SUBROGATION IS WAIVED, subject 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 HUB se Insurance Serv. Inc. License #0757776 6701 Center Dr. West #1500 CD TACT NA E: Tarry Decker PHONE 714. 922.4229 A Ex1; No); e•Maa° „(AC ADDRESS; Cal.CPU @hubinternational.com -- --- - -- INSURER 3) AFFORDING COVERAGE NAIC If Los Angeles, CA 90045 INSURER A: Great American Co. 26344 INSURED Thomas House Temporary Shelter PO BOX 2737 INSURER B: State Compensation Ins. FLlnd 35076 INSURER C: $1,000,000 INSURER D: X, COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1:9 OCCUR Garden Grave, CA 92842 INSURER E: INSURER P: PREMISS AENTE enea $100,000 COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. LTR TYPE OF INSURANCE N MR SUB 0 POLICY NUMBER POLICY EFF MMIDD/YYW POLICY E %P MMIDO/YYVY LIMITS • GENERAL LIABILITY PAC0594539 10/031201410/031201 EACH OCCURRENCE $1,000,000 X, COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1:9 OCCUR PREMISS AENTE enea $100,000 MED EXV (Any one person) $51000 PERSONAL &ADV INJURY $100000Q GENERAL AGGREGATE $2,000 000 GEN'L AGGREGATE POLICY LIMIT APPLIES PER: JGCI' LOC PRODUCTS - COMP/OP AGG $2,000000 • AUTOMOBILE LIABILITY PAC0594539 10/031201410/03 /201 CeaecgeDtswGLEUMIT 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUT03 X AUTOS BODILY INJURY For accident) .$ PROPERTY DAMAGE Perac"," $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS.MAOE! EACH OCCURRENCE $ AGGREGATE $ LED RETENTION$ $ B WORKERS COMPENSATION ANOEMPLOVERS'LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICERIMEM3ER EXCLUDED NIA 488156614 10101/201410/01 /201 X WC STAT -U OTH- _TQRYLIML E.L. EACH ACCILENT $1000000 E.I.. DISEASE - EA EMPLOYEE S1,000,OOO (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below _ E.L. GISEASE POLICY LIMIT $1 000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS [VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) City of Santa Ana, its officers, officials, agents, and employees are additional insured in regard to General Liability per attached form CG822412101. City of Santa Ana Attn: Terri Eggars 20 Civic Center Plaza Santa Ana, CA 92701 ACORD 25 (2090105) 1 of 1 #S3131489/M3116229 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL DE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE U Teee -ZULU AWKU CORPORATION: All rights reserved, The ACORD name and logo are registered marks of ACORD SC45