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1*i I CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDDIV" 6/29/2015 5 <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 endorsements . <br />PRODUCER <br />Milestone Risk Management & Insurance Agency <br />License No. OB72766 <br />8 Corporate Park, Suite 130 <br />Irvine CA 92606 <br />CONTACT Teresa Shen <br />NAME: <br />PHONE (949)852 -0909 FAX ,(949)852 -1131 <br />nDOAIE ,tshen @milestonepromise. com <br />INSURERS AFFORDING COVERAGE <br />HARD# <br />INSUREnA;Technology Insurance Co <br />42376 <br />INSURED <br />Council on Aging of Orange County <br />1971 E 4th St, Ste 200 <br />Santa Ana CA 92705 <br />INSURERB:SCottsdale Indemnity Co. <br />15580 <br />INSURERC:A%ie Insurance Co. <br />37273 <br />INSURER D: <br />INSURER E <br />$ <br />INSURER F: <br />COMMERCIAL GENERAL LIABILITY <br />COVERAGES CERTIFICATE NUMBER:15 /16 Master 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 />ADDLSUBIR <br />WPM <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDNYYY 1 <br />POLICY EXP <br />?MM/DD/YYYYi <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br />COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ <br />MED EXP (Any one person ) <br />$ <br />CLAIMS -MADE 71 OCCUR <br />PERSONAL & ADV INJURY <br />$ <br />GENERAL AGGREGATE <br />$ <br />GEN'L AGGREGATE <br />LIMIT APPLIES PER <br />PRODUCTS - COMP /OP AGG <br />$ <br />POLICY <br />PRO- LOC <br />JFCT <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />P <br />BODILY INJURY (Per accident) <br />t id <br />( ) <br />$ <br />HIRED AUTOS NON-OWNED <br />PROPERTY DAMAGE <br />(Par accidan) <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR /PARTNERJEXECUTIVE <br />MandamMEn NH EXCLUDED? <br />(Mandatory ) <br />N/A <br />C3452204 <br />1/1/2015 <br />1/1/2016 <br />X TWO STATU- OTH- <br />-LIMITS <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE EA EMPLOYEE <br />$ 1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />B <br />D &O / Emp Practices Liab <br />RI3142145 <br />11/13/201411/2/2015 <br />Limit $1,000,000 <br />C <br />E &O / Media Liability <br />CN000080281401 <br />11/2/2014 <br />11/2/2015 <br />Limit $1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <br />RE: Evidence of Coverage. <br />�OL�ry <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2010/05) <br />INS025 (201005).01 <br />© 1988 -2010 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 CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza, M -25 <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92701 <br />Teresa Shen /TERESA C= -9 <br />ACORD 25 (2010/05) <br />INS025 (201005).01 <br />© 1988 -2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />