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Client #;758615 THOMHOUS ACORD,, CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DD/YYYY) 1010912014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, -- - - --- --- -- --- -- .._____-) - - _W..______ IMPORTANT; If tho cortifloate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION I8 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ilou of such andorsement(s). PRODUCER HUB tnt'i Insurance Serv. Inc. License #0757776 6701 Center Or. West #1500 CD,N TA NAME; Terry Decker P ONE A�c Na a :t; 714.922.4229 A ; ac wa �- EMAIL b ""') " " "` DoRE @s;,,- CaLCPU @hu internatlonaLcom _ ........ .......__�_e............._....� ......_�..._...., . Los Angeles, CA 90045 INSURER B) A{ FFORDING CoVFRAGE INSURERA: Great American Assurance Co. NAIC p 26344 INSURED Thomas House Temporary Shelter PO Box 2737 INSURER a: State Compensation Ins. Fund 35076 - - -- INSURER C INSURER D: Garden Grove, CA 92842 INSURER E: $100 000 INSURER F: $S OOO PERSONAL &ADV INJURY COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLSUB 1 POLICY NUMBER POLICY EFF MMIDD/Yl'Y PppII,,I0 E %P MMIDD LIMITS fA GENERAL LIABILITY PAC0594539 10/03/2014 10/031201 EACH OCCURRENCE $1 000 000 X, COMMERCIAL GENERAL UAMIJr 'CLAIMS -MADE ®OCCUR _ P EMIS S Ea accu nce $100 000 _ MED E %P (An one person $S OOO PERSONAL &ADV INJURY $U0001000 GENERAL AGGREGATE s2,000000 GEHL AGGREGATE LIMIT APPLIES PER PRODUCTS. COMMOPAGG $2000000 POLICY PRO LOC A AUTOMOBILE LIABILITY PAC0594539 10/03/2014 10/03/21 COMBINED INGLE LIMIT A. 51,000,000 BODILY INJURY (P¢rpemon) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED A IT BODILY INJURY eccitleot ) $ X PROPERTY DAMAGE P¢r accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE AGGREGATE $ EXCESS UAS CLAIMS -MADE DED RETENTION $ B WORKERS COMPENSATION AND EMFLOVERS`UABILITY YIN ANY PROPRIETOWPARTNER /EXECUTIVE OFFICER/MEMBI EXCLUDED? ❑ N/A 488156814 10/01!201410/01 /201 X WC STATU• OTH- Y E,L. EACH ACCIDENT $1 OOO OOO E.L. DISEASE - EA EMPLOYEE $1 OOO OOO (Mandatory In NH) i Dyy¢e SORPTION under DE9L�RIPTION OF OPERATIONS below � _ E.L. DISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) City of Santa Ana, its officers, officials, agents, and employees are additional Insured in regard to General Liability per attached form CG822412101. City of Santa Ana Attn: Terri Eggers 20 Civic Center Plaza Santa Ana, CA 92701 ACORD 25 (2010105) 1 of 1 #S3131489/M3116229 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE v 1Udd -LU1U ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SC45