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<br />P ATE (MMiODNYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 6/2912015
<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 palicy(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 License # 0564249 CONTACT
<br />NAME:
<br />Heffernan, Insurance Brokers -PHONE FAx
<br />1 714)1-3.61 7700 ( 1
<br />6 Hutton Centre Drive, Suite 500 Arc Na E�tL {_..._... I (Ate Nod 1. (7148 351 7701
<br />Santa Ana, CA 9!2707 E -MAIL
<br />ADDRESS:
<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 />INSURER(S) AFFORDING COVERAGE
<br />NAIL #
<br />EXCLUSIONS AND CON'DITI'ONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSURER A: Nonprofits Insurance Alliance of California
<br />01,184
<br />INSURED
<br />INSURER B: Berkshire Hathaway Homestate Insurance Company
<br />20044
<br />Human Options
<br />INSURER C:
<br />PO Box 53745
<br />INSURER D:
<br />Irvine, CA 92619
<br />_ _.-
<br />X
<br />INSURER E
<br />0912312.015
<br />AMAGE'TO -DAMAGE
<br />09/2312016
<br />INSURER P:
<br />rr)VF'RACFS (CI= RTIPI(`ATF NIIMFCFR' I?GY /ICIC1hl milklimc0.
<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 CON'DITI'ONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR __... - °ADDS SUSIR ............. ..._.. �POLICY EFF .....POLICY EXP - �........ ..... - -...
<br />LTR TYPE..OF INSURANCE INSR WVD POLICY NUMBER i MMIDD/YYYY MMIDWYYYY LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />AUTHORIZED REPRESENTATIVE
<br />Santa ,Dina, CA 92701
<br />EACH OCCURRENCE
<br />$.. 1,000,000
<br />.
<br />CLAIMS [ X' OCCUR
<br />X
<br />201501143NPO
<br />0912312.015
<br />AMAGE'TO -DAMAGE
<br />09/2312016
<br />_ .._ _ -.._..
<br />500,000
<br />-MADE
<br />PREMISES (Ea occurrence)
<br />$
<br />..
<br />__
<br />MED EXP (Any one person)
<br />$ 20,000
<br />PERSONAL &ADVINJURY
<br />$ 1,000,000
<br />L AGGREGATE LIMIT APPLIES PER:
<br />G
<br />GENERAL AGGREGATE
<br />$ 3,000 „000
<br />POLICY' PRO- -Or
<br />JECT -'
<br />PRODUCTS - COMPlOP AGG
<br />_
<br />$ ... 3,000,000
<br />_
<br />OTHER
<br />SEXUAL MISCONDU
<br />$ 1,000,000
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />$ 1,0 00,000
<br />A
<br />201501143NPO
<br />09/2312015
<br />09123/2016
<br />person)
<br />BODILY INJURY Per pccndenty
<br />S
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />�
<br />BODILY INJURY (Per a n
<br />S .
<br />NON-OWNED
<br />�
<br />- PROPERTY DAMAGE
<br />... .......
<br />� $
<br />HIRED AUTOS
<br />(P Or accident )
<br />_L-
<br />$
<br />X UMBRELLA LIAR X� OCCUR
<br />EACH
<br />li S 5 000 000
<br />/{
<br />..,,, EXCESS LIAR OCCUR MADE
<br />EXCESS
<br />2 15 1143UMBNPq
<br />0912312015
<br />09123120'16
<br />AGGREGATE
<br />..,..
<br />S 5,000,000
<br />)1 RETENTI bN$ 10,000!
<br />...........I
<br />-i1
<br />$
<br />WORKERS COMPENSATION
<br />PER OTH-
<br />AND EMPLOYERS' LIABILITY
<br />Y�
<br />STATUTE ., ER
<br />,..., _._.
<br />B ANY PROPRIETORIPARTNEWEXECUTiVE
<br />H'UWC703947
<br />0410112016
<br />0410112017
<br />E.L. ACH ACCIDENT
<br />$ 1,000,000
<br />NIA
<br />OFFICERW MEEREXCLUDED? !°nf
<br />— _..
<br />....._. ....
<br />(Mandatory 1n NH)
<br />E.L. DISEASE - EA EMPLOYEE
<br />S 1,000,000
<br />Bf yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />,.,....
<br />E.L. DISEASE -POLICY LIMIT
<br />L...-.--..._ ..,0,0
<br />$ 1,00 0 000
<br />A
<br />Professional Liabili
<br />201501143NPO
<br />0912312015
<br />0912312016
<br />Occurrence 1,000,000
<br />A
<br />Sexual Misconduct
<br />201501143NPO
<br />0912312015
<br />0912312016
<br />Occurrence 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 141, Additional Remarks Schedule, may be attached if more space is required) - --
<br />Re: As per Contract or Agreement on file with Insured. The City of Santa Ana, its officers, employees, agents and volunteers and representatives are included
<br />as an additional Insured (and primary) on General Liability policy per the attached endorsement, if required _.
<br />I
<br />rI= RTII =IrdTP wni npp r AhlrFi i ATInM
<br />1996 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />Im
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Community Development Agency
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />20 Civic Center Plaza, M -25
<br />AUTHORIZED REPRESENTATIVE
<br />Santa ,Dina, CA 92701
<br />I
<br />i
<br />1996 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />Im
<br />
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