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ACC)Rr► CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDIYYYY) <br />11/5/2015 <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(ies) 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 <br />Milestone Risk Management & Insurance Agency <br />License No. 0872766 <br />S Corporate Park, Suite 130 <br />Irvine CA 92606 <br />CONTACT <br />NAME: Teresa Shen <br />PHONE (949) 852 -0909 FAX N� .1949)852 -1121 <br />i. <br />Eµ MAIL tshen @milestonepromise.com <br />INSURERS. AFFORDING COVERAGE <br />NAIL# <br />INSURER A :Technolo gy Insurance Co <br />42376 <br />INSURED <br />Council on Aging of Orange County <br />1971 E 4th) St, Ste 200 <br />Santa Ana ALA 92705 <br />INSURERe:Sc.ottsdale Indemnity Co. <br />15550 <br />INsuRER c his Insurance Co. <br />37273 <br />INSURER D:: <br />INSURER E: <br />$ <br />INSURER F:... <br />II <br />COVERAGES CERTIFICATE NUMBER:15 /16 Master REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE 'P'OLICIES 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 FATHER 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 />IIINSR <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ILTR <br />I TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />MMJODIYYYY ) <br />POLICY EXP <br />IIMWDDrYYYYj <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br />COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />PREMISES jEg occurrence <br />MED EXP (Any one person) <br />_$ <br />$ <br />CLAIMS -MADE F—I OCCUR <br />PERSONAL S ADV INJURY <br />$ <br />GrNPRALAGGREGATE <br />$ <br />''.... GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMRiOP AGG <br />$ <br />POLICYF7 PRO - LOO <br />$ <br />AUTOMOBILE <br />LIIABILITY... <br />COMBINE[) SINGLE LIM'IT.... <br />Ea accident <br />$ <br />BODILY INJURY (Per person,) <br />$� <br />ANY AUTO <br />ALL OWNED '.. SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />NON-OWNED <br />HIRED AUTOS AUTOS <br />PROPERTY DAMAGE <br />Per anoidonP <br />$ <br />UMBRELLA L1AB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />HCLAIMS-MADE <br />''i AGGREGATE <br />''... $ <br />EXCESS LIAR <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILIITY Y / N <br />i. WVC STATU -gTH- <br />'...... <br />E.LEACHACCIDENT <br />S l 000 000 <br />A <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />PPICEHIMFMBE <br />(Manda ory in NHS EXCLUDED? <br />NIA <br />WC3452204 <br />1/1/2015 <br />1/1/2016 <br />E.L. DISEASE - EA EMPLOYEE <br />'$ 1,000,000 <br />It yes, describe under <br />.'....'"" <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1 00B 000 <br />B <br />D &O / Emp Practices Limb <br />EKI3142145 <br />11/2/2015 <br />11/2/2016 <br />Limit $1,000,000 <br />C <br />E &O / Media Liability <br />MCN000080281501 <br />11/2/2015 <br />11/2/2016 <br />Limit $1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 1'.01, Additional Remarks Schedule, if more space Is required) <br />RE: Evidence of Coverage. <br />rFR'TIFW.ATF HOLDER rANrFI I ATIrSNI <br />ACORD 25 (2010/05) <br />INS025 (201005y.01 <br />@ 1988-2010 ACORD CORPORATION. Aft 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 />ii <br />Teresa Shen /TERESA- <br />ACORD 25 (2010/05) <br />INS025 (201005y.01 <br />@ 1988-2010 ACORD CORPORATION. Aft rights reserved'. <br />The ACORD name and logo are registered marks of ACORD <br />