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ORANCOU-19 VMXHAVERI
<br />Acc7r2® CERTIFICATE OF LIABILITY INSURANCE
<br />�--��
<br />DATDIYYYY)
<br />10/3/2014
<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 License # 0726293
<br />Arthur J. Gallagher & Co. Insurance Brokers of CA., Inc.
<br />505 N Brand Blvd, Suite 600
<br />Glendale, CA 91203
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />(AIC Ne ExR: (818) 539.2300 AICNe)_ (818) 53972301 _.
<br />ADDRESS:
<br />r
<br />IN$BRER($)AFFORDING COVERAGE I NAIC#
<br />10/0112014
<br />_
<br />INSURERA: Great American Insurance Company ;1_6691_
<br />INSURED
<br />INSURER B: Great American Insurance Company of NY
<br />Orange County Conservation Corps
<br />1853 N. Raymond Ave.
<br />_122136
<br />INSURER C:NonProfits United I__
<br />INSURER D: Hanover Insurance Company W29
<br />_ -2 --
<br />INSURER E:
<br />Anaheim, CA 92801
<br />Anaheim,
<br />INSURER F
<br />_
<br />$
<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 />INSR
<br />LTR.
<br />TYPE OF INSURANCE
<br />DOL
<br />D
<br />SUBR
<br />WVO
<br />POLICY NUMB ER
<br />POLICY EFF
<br />MMIDDNYYY
<br />POLICY EXP
<br />MMIDDIYYYV
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />EXH
<br />PAC5154680
<br />10/0112014
<br />10/01/2015
<br />EACH OCCURRENCE II$ 1,000,000
<br />AG TO RENTED
<br />PREMISES Ea occurrence $ 100,000
<br />MED EXP(Any one person) 5 Sr000
<br />PERSONAL B ADV INJURY $ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />r POLICY J PRO E LOC
<br />JECT
<br />OTHER
<br />GENERAL AGGREGATE '$ 3,000,000
<br />PRODUCTS - COMPIOP AGG $ 3,000,000
<br />_
<br />$
<br />B
<br />AUTOMOBILE LIABILITY
<br />X ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON OWNED
<br />X HIRED AUTOS X AUTOS
<br />!---if
<br />CAP0991249
<br />10/0112014
<br />10101/2015
<br />COMBINED SINGLE LIMIT 1,000 000
<br />(Ea accident)
<br />_!J_ _
<br />BODILY INJURY (Per person) $
<br />_
<br />BODILY INJURY(Peraccidenp $
<br />PROPERTYD AMAGE
<br />Per so idem $_
<br />$
<br />A
<br />UMBRELLA LIAR
<br />EXCESS LIAU
<br />OCCUR
<br />CLAIMS -MADE
<br />UMB 5603795
<br />11010112014
<br />1010112015
<br />EACH OCCURRENCE $ .1,000,000
<br />AGGREGATE $
<br />OED X RETENTION$ 10,0001
<br />1,000,000 $ 1,000,000
<br />C
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED? ❑
<br />(MandntoryinNH)
<br />If yes, describe no.,
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />NPU-WCG 001-2014
<br />0110112014
<br />0110112015
<br />X PER OThI-
<br />STATUTE ER
<br />EL EACH ACCIDENT $ 1,000,000
<br />--
<br />E.L. DISEASE - EA EMPLOYEEI$ 1,000,000
<br />_ -
<br />E.L. DISEASE -POLICY LIMIT I $ 1,000,000
<br />D
<br />Directors &Officers
<br />LH3 9817317 01
<br />1212812013
<br />I
<br />12128/2014
<br />Each Claim 2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The City of Santa Ana, its officers, agents, employees and volunteers, and the State of California, its officers, employees, and volunteers are named additional
<br />insured/Funding Source with respect to the operations of the named insured per the attached CG 2026 endorsement. Such insurance is Primary and
<br />Non -Contributory. Workers Compensation coverage excluded, evidence only.
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<br />CERTIFICATE HOLDER CANCELLATION
<br />© 1968-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Cit Of Santa Ana, Workforce Investment Board
<br />Y
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />1000 E. Santa Ana Blvd„ Ste. 200
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />EXH
<br />I
<br />© 1968-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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