|
ILLUFOU-01 LOROZCO
<br />CERTIFICATE OF LIABILITY INSURANCE Da9t2✓'12016 )
<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 tlou of such endorsement(s).
<br />PRODUCER License # ODT9613 NA'mTTA Lizette Orozco
<br />Bowermaster & Associates Insurance Agency, Inc, HONE EXOo 714) 733.6200INC,No : (714) 252.8253
<br />10805 Holder Street, Suite 360 A/C
<br />Cypress, CA 90630 ADDRess,
<br />INSURED
<br />Illumination Foundation
<br />2691 Rfohter Avenue
<br />Suite 107
<br />Irvine, CA 92800
<br />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 CONTRACTOR OTHER DOCUMENTWITH RESPECT TO
<br />WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES
<br />DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY
<br />PAID CLAIMS,
<br />LTR TYPE OF INSURANCE 16n MD POLICY NUMBER M�f)ph FF
<br />CYEXP
<br />MMIODIY LIMITS
<br />A X
<br />I COMMERCIAL GENERAL LIABILITY
<br />mm
<br />EACH OCCURREPICE $
<br />1,000,000
<br />CLAIMS -MADE EXIOCCUR X 201624712NPO
<br />0011612015
<br />09/15/2016
<br />PREMISES (Eeoccurretoo) $
<br />600,000
<br />MED IXP(,gny cne oerson) $
<br />20,000
<br />PERSONAL& ADV INJURY E
<br />1r000,00
<br />GENERALAGGREGATE $
<br />3,000,000
<br />GEM,
<br />AGGREGATE UMI i'APPLIES PER;
<br />%(
<br />POLICY ❑ PRO-JEC7 D LOC
<br />PRODUCTS - COMPIOP AGG$
<br />00,
<br />3;0000
<br />_
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />_OM
<br />LINE D SINGLE LIMIT $
<br />-Le eccldenn
<br />1,000,000
<br />.0
<br />B X
<br />ANY AUTO BAW56316571
<br />09/1612016
<br />09/15/2016
<br />BODILY INJURY (Per person) s
<br />ALL OWNED SCHEDULEDp
<br />AUTOS
<br />BODILY INJURY (Par acolddnU $
<br />X
<br />-X NOTN-OWNED
<br />HIREDAUTOS ALTOS
<br />—PROPERTY ,
<br />Par eccideng ,
<br />$
<br />.X
<br />UMBRELLALIAB X OCCUR T
<br />EACHOCCURRENCE $
<br />4,000,000
<br />A
<br />EXCESS LIAR CLAIMS -MADE 201624712UMBNPO
<br />09116/2016
<br />09/1512016
<br />AGGREGATE $
<br />4,000,000
<br />OED X RETENTION$ 10,000
<br />$
<br />WORKERS COMPENSATION
<br />'LIABILITY
<br />AND EMPLOYERS
<br />YINANY
<br />L. EACH ACCIDENT S
<br />OFFIQERAVEIGMNH EXCUDDEDD?EGUTIVE NIA
<br />I DISEASE -EA EMPLOYEE S
<br />IryyeS, deSC"be Under
<br />DESCRI PIIONOFOPERAIIONSUebw _
<br />E.I., DISEASE -POLICY LIMIT S
<br />A Professional Llab. 201524712NPO 09/1612015
<br />09/1512016 Occ:$1,000,000 /Agg
<br />3,000,000
<br />A Improper Sexual Cond 201524712NPO 09'1612015
<br />09/1512016 Occurrence/Agg
<br />210:(
<br />Pn$CMPTiONOFOPERATiONSIL00ATiONSiVeHiCLEE (ACORD tat,Addttfonai Ramarka echadnia, may ha anachedymere space is mquirady
<br />RE: HPRP Compact #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 000010798.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza, 111145 ACCORDANCE WITH THE POLICY PROVISION$,
<br />Santa Ana, CA 92701 --
<br />AUTHORIZED REPRESENTATIVE
<br />01988.2014 ACORD CORPORATION. All rights reserved,
<br />ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
|