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-^� ILLUFOU -01 LOROZCO
<br />`xyf CERTIFICATE OF LIABILITY INSURANCE DA1 /28 /20 6YYI
<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($), 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 endorsement(s).
<br />PRODUCER License # 0079613
<br />Bowermastor & Associates Insurance Agency, Inc.
<br />10806 Holder Street, Suite 360
<br />Cypress, CA 90630
<br />INSURED
<br />Illumination Foundation
<br />2691 Richter Avenue
<br />Suite 107
<br />Irvine, CA 92606
<br />S) AFFORDING COVERAGE
<br />Insurance Alliance of California
<br />West American Insurance
<br />COVERAGES CERTIFICATE NUMBER: 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
<br />DESCRIBED HEREIN IS SUBJECT TO ALL THE
<br />TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />Ql Y
<br />OFINSURANCE POLCYNUI MM7DDY Ff Y
<br />LTR p
<br />POLICY LIMITS
<br />YYINSR
<br />MMtDOY
<br />_
<br />A X I COMMERCIAL GENERAL LIABILITY
<br />EACHOCCURRENCE $
<br />1,000,000
<br />CLAIMS -MADE IK OCCUR X 201524712NPO 091`1512015
<br />09/1512016 PREMISES Ee occurcence�„ $
<br />600,000
<br />MED EXP (Any one parso-n) $
<br />20,000
<br />PERSONAL &ADV`INJURY $
<br />1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $
<br />3,000,000
<br />X POLICY ❑ .iPRO- EGT 0 LOD
<br />PRODUCTS - COMPfOP AGO $
<br />3,000,000
<br />OTHER'.
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT $
<br />Ea accident
<br />1,000,000
<br />B X_ ANY AUTO BAW56316671 09/95/2015
<br />0911512016 BODILY INJURY (Per person) $
<br />ALLOWNED SCHEDULED
<br />BODILY INJURY (Per accident) $
<br />_ AUTOS _ AUTOS
<br />X X NON -OWNED
<br />PROPERTY DAMAGE $
<br />HIREDAUTOS AUTOS
<br />eer accl,fenU
<br />_
<br />$
<br />X UMBRELLA LIAB X OCCUR
<br />EACH OCCURRENCE $
<br />4,000,00
<br />• EXCESS LIAR CLAIMS -MADE 201524712UMBNPO 09/1512015
<br />09/15/2016 AGGREGATE $
<br />4,000,000
<br />DED X RETENTION $ 10,000
<br />$
<br />WORKERS COMPENSATION
<br />m PER pTH-
<br />STATUTE ER
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR)PARTNEWEXECUTIVE
<br />E,L, EACH ACCIDENT $
<br />OFFICERtMEMBER EXCLUDED? ❑ VIA
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYE $
<br />it pns, describe.rav,
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $
<br />_
<br />• Professional Liab, 201524712NPO 09/15/2015
<br />0911512016 Occ:$1,000,000 /Agg
<br />3,000,000
<br />• Improper Sexual Cond 201524712NPO 09/16/2015
<br />09/15/2016 Occurrence /Agg
<br />250,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES (ACORD 1a1, Addfttomi Romark& Schedule, may be aHachw ip more space Is requlrad}
<br />RE: HPRP Contract #A -2009 -137 Homeless Prevention and A- 2009.137A Rapid Re- Housing
<br />City of Santa Ana, their officers, officials, employees, agents and volunteers are Additional Insureds per attached #CG2026 endorsement with primary
<br />wording per policy form CC00010798.
<br />``
<br />� Vv
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City f Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />tY
<br />20 Civic Center Plaza, M -25 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701 - --
<br />AUTHORIZED REPRESENTATIVE
<br />©1988 -2014 ACOR
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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