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ILLUFOU-01 LOROZCO <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE F <br />11/28!28/2416 <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 13Y THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sj, AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pOiicy(ies) must be endorsed. If SUBROGATION 15 WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confor rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER License # OD79613 <br />Bowermaster & Associates Insurance Agency, Inc. <br />10805 Holder Street, Suite 350 <br />Cypress, CA 90630 <br />CONTACT <br />NAME: Lizette Orozco <br />PHONE 714 733-6200 FAX 714 252 8253 <br />Arc No Ext : ( ) (AIC Nol: i ) <br />ADE-MAIL <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />A <br />INSURERA:Noriprofits' Insurance Alliance of California <br />COMMERCIALGENERALLIABILITY <br />CLAIMS -MADE ❑X OCCUR <br />INSURED <br />INSURER B : West American Insurance <br />Illumination Foundation <br />2691 Richter Avenue <br />Suite 107 <br />INSURER C <br />INSURER D <br />INSURER E; <br />Irvine, CA 92606 <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER- RFVICInN nil URII <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 CONTRACTOR 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 />ILTR <br />TYPE OF INSURANCE <br />ADDL <br />!NSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY EXP <br />MMIDDIYYYY <br />LIMITS <br />A <br />X <br />COMMERCIALGENERALLIABILITY <br />CLAIMS -MADE ❑X OCCUR <br />X <br />201524712NPO <br />0911612015 <br />09115/2016 <br />EACH OCCURRENCE $ 1,000,000 <br />T 500 D00 <br />PREMISES Ea occurrence $ <br />MED EXP (Any one person) $ 20,000 <br />PERSONAL&ADV INJURY $ 1,000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY1:1 PRO- <br />JECT [:] LOC <br />GENERALAGGREGATE $ 3,000,000 <br />GEN'L <br />X <br />PRODUCTS - COM PIOPAGG $ 31000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />CO 86CI.ED SINGLE LIMIT $ 1,000,UI}4 <br />X <br />ANY AUTO <br />SAW56316571 <br />09!1512015 <br />09115l201fi <br />BODILY INJURY (Per parson) $ <br />ALLOWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per $ <br />( ) <br />X <br />NON -OWNED <br />HIRED AUTOS X AUTOS <br />PROPERTY DAMAGE <br />Per accident) $ <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE $ 4,000,000 <br />A <br />EXCESS LiAB <br />E7DED <br />CLAIMS -MADE <br />201524712UMBNPO <br />09115/2015 <br />09115/2016 <br />AGGREGATE $ 4,000,000 <br />X RETENTION $ 14,444 <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROP RIETORfPARTNERlEXECUTIVE <br />OFFICERIMEMDEREXCLUDED9 <br />N!A <br />PER OTH- <br />STATUTE ER <br />E. L. EACH ACCIDENT $ <br />E. L.DI5FASE-EA EMPLOYEE $ <br />(Mandatory In NH) <br />If yes, describe under <br />E.L. DISEASE -POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS below <br />A <br />Professional Liab. <br />201624712NPO <br />0911512015 <br />09/15/2016 <br />Occ:$1,0003000 /Agg 3,000,000 <br />A <br />Improper Sexual Cond <br />201524712NPO <br />0911512015 <br />09/15/2016 <br />Occurrence/Agg 250,000 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD ia1, Additional Remarks Schedule, may be attached if more space is required) <br />RE: HPRP Contract #A-2009-137 Homeless Prevention and A -2009-137A Rapid Re -Housing <br />City of Santa Ana, their officers, officiafs, employees, agents and volunteers are Additional Insureds per attached #CG2026 endorsement with primary <br />wording per policy form CG00010798. <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2014101) <br />O 1988-2014 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 />City of Santa Ana <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />20 Civic Center Plaza, M-25 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2014101) <br />O 1988-2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />