|
CERTIFICATE(JF LIABILITY INSURANCE
<br />ATE (MMPDDIYYYY)
<br />P2/10/2017
<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(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.
<br />CONTACT Nilda Garcia
<br />NAME:
<br />Flays Companies
<br />fFAX
<br />Ed. (909)243-8911 Bx N Ext)AdC,NoI:
<br />__�.._.
<br />4200 Concours, Suite #350
<br />E-MAIL
<br />ADDRESS: n )rola@hayscump aneis,conm r
<br />INSURERS) AFFORDING COVERAGE NAIL
<br />INSURERA:Great American Ins. Co. of NX 22136 ._
<br />Ontario CA 91764
<br />INSURED
<br />Boys & Girls Clubs of Central Orange Coast N/
<br />INSURERB:Insurance Company of the West 27847
<br />INSURER C:
<br />INSURER D:
<br />250 N Golden Circle Suite 104
<br />''. INSURER E:
<br />INSURER F
<br />Santa Ana CA, 92705
<br />COVERAGE'S CERTIFICATE NUMBER:CL1721035592 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 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />.........
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMVDDIYYY Y
<br />POLICY EXP
<br />IMIM%IDD,NYYY
<br />LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />A
<br />CLNMS-MADE Ix I OCCUR
<br />DAMAGEENTED 300,010..
<br />PREMISES-LEEaaoccurrence $
<br />MEO EXP (Any one person) $ 10,000
<br />X
<br />PAC4614128 '"
<br />2/11/2017
<br />2/11/201¢3
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />GEN"L AGGREGATE LIMIT APPLIES PER:.
<br />GENERAL AGGREGATE $ 3,000,000
<br />PRO-
<br />POLICY JECT1:1 LOG
<br />PRODUCTS - COMP/OP AGG $ 3,000,000
<br />OTHER:.
<br />SEXUAL ABUSE COV $ 1,000,000
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT $ 1,000,000
<br />Ea accAen0
<br />A
<br />X.
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />CAP461412'.9 '/
<br />2/11/2017
<br />2/11/2019
<br />BODILY INJURY(Per accvdenO $
<br />NON -OWNED
<br />PROPERTY DAMAGE .. $ ..
<br />HIRED AUTOS AUTOS
<br />(Per accident) .m...... .....
<br />Medical payments $ 5,000
<br />X
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 5 O00 000
<br />AGGREGATE $ __
<br />A
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED X RETENTION$ 10 000
<br />$
<br />UMB461413,0
<br />2/11/2017
<br />2/11/201B
<br />WORKERS COMPENSATIONX.
<br />PER 0TH_
<br />AND EMPLOYERS" LIABILITY YIN
<br />STATUTE. ER
<br />E.L. EACH ACCIDENT $ 1,00(}, OOQ
<br />ZANY PROPRIETORI'PARTNERIEXECUTIVE
<br />OFFICER/10FNIBER EXCLUDED?
<br />NPA
<br />,.
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />(Mandatory In NH)
<br />WV.B 5033839 01
<br />6/1/2016
<br />6/1/2017'
<br />It yes, describe Conder
<br />'
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />A
<br />Property R/C: Spcl Farm
<br />PAC461..4128
<br />2/11/2017
<br />2/11/2.018
<br />Blanket BPR $876.000
<br />Deductible: $1,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS P VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of ,Santa Ana, Community Development Agency is Additional Insured; With respect to claims arising out
<br />of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded
<br />by this policy is primary and is not additional to or contributing with any other insurance carried by or
<br />for the benefit of the additional insureds; Primary & Non -Contributory wording applies per attached
<br />Signature GL Broadening Endorsement form ( CG 89 70)
<br />City of Santa. Ana, Community "
<br />Development Agency
<br />20 Civic Center Plaza, M-25
<br />Santa Anna, CA 92701
<br />6A,NII. tLLA I IUN
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF', NOTICE WILL. BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />AUTHORIZED REPRESENTATIVE.
<br />F^le r a h a n/ U G:4iiC C
<br />Q 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />INS025 r2m4ni ti
<br />M
<br />
|