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ILLUFOU-01 MWO DS
<br />DATE. IMWOD/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 101412016
<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(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)..
<br />PRODUCER. License # 0079613 CONTACT
<br />. NAA'(:—.......
<br />Bowermaster 6r Associates Insurance Agency, Inc. PHONE FAX
<br />10805 Holder Street„ Suite 350 (A1C, No, Ext) (714) 733=6200AIC .,.Na!�(714) 252-8253
<br />E-MAIL ......... 733-6200(AJC !
<br />(Cypress, CA 90630 ADDRESS:
<br />INSURED
<br />Illumination Foundation
<br />2691 Richter Avenue
<br />Suite 107
<br />Irvine, CA 92606
<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
<br />OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED
<br />BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE
<br />BEEN REDUCED BY PAID CLAIMS.
<br />INSR. ADDLiSUBR --
<br />LTRTYPE OF INSURANCE POLICY NUMBER
<br />POLICY EFF POLICY EXP _.
<br />O M IDD 'LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />1,..000 000
<br />$
<br />CLAIMS -MADE ._....� OCCUR X
<br />�_
<br />�/
<br />X
<br />201624712NPO
<br />0911512016
<br />09115/2017
<br />DAMAGE TO RENTED
<br />PRPMSE$, O,CGG1fP3n CL'
<br />500, 000
<br />$
<br />(Any o�e.,persan
<br />$ 20,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />_...........
<br />GEW L AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE
<br />3,000,000
<br />$__,_,.,.
<br />X POLICY F1 PRJEOT o- 1:1 LOC
<br />PRODUCTS - DOM PYOPAGG -
<br />3,000,000
<br />S
<br />OTHER:
<br />UTO
<br />AUTOMOBILE
<br />:.
<br />COMBINFQIN
<br />SGLE LIMIT
<br />NY AUTOLIAHILITY
<br />BAWS6316571
<br />0911512016
<br />0,911512017
<br />BODILYdINJ1URY Per person)$
<br />----1,00®,.000,,
<br />OWNED SCHEDULED
<br />.....................—
<br />-----............,..., .. _
<br />AUTOS ONLY AUTOS
<br />BO-DILY INJURY (Per acciden)
<br />$
<br />HIREDNON-OWNED
<br />PROPERTY DAMAGE
<br />AUTOS ONLY AUTOS ONLY
<br />'Per acadanl.
<br />$
<br />_..:_
<br />$
<br />A
<br />X
<br />UMBRELLA LIAR X OCCUR
<br />EACH OCCURRENCE...............
<br />$ 2,000„000..
<br />_
<br />�.
<br />EXCESS LIAR CLAIMS -MADE
<br />201624712UMBBNPO
<br />0911512016
<br />0911512017
<br />000 000
<br />2,000,000
<br />f DED I X I RETENTION S 10,000
<br />_AGGREGATE.
<br />$
<br />$
<br />WORKERS COMPENSATIONPER
<br />AND EMPLOYERS' LIABILITY
<br />OTH
<br />STATUTE ER
<br />Y / N
<br />ANY PROPRIETORIPARTNEWEXECUTIVE
<br />` N 1 A
<br />E.L. EACH ACCIDENT .....,.
<br />S
<br />- .
<br />5
<br />OFFICEWMEMBER EXCLUDEDB
<br />(Mandatory In NH)
<br />E.L_ DISEASE- EA EMPLOYEE
<br />If yes, describe under
<br />'
<br />DESCRIPTION OF OPERATIONS below
<br />I E.L. DISEASE -POLICY LIMIT
<br />S
<br />A
<br />Professional Liabili
<br />201624712NPO
<br />0911512016
<br />0911512017 iOcc. $1,000,0001Agg
<br />3,000,000
<br />A
<br />Improper Sexual Cond
<br />I
<br />�201624712NPO
<br />0911512016
<br />0911612017',Occurrence/Agg
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES IACORD 101, Additional Remarks Schedule,
<br />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, officials, employees, agents and volunteers are Additional Insureds per attached #CG2026 endorsement with primary wording
<br />per policy form CG00010798.
<br />�w w.f ww , Fp
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Ci of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL
<br />BE DELIVERED IN
<br />20 Civic Center Plaza, M-25
<br />ACCORDANCE WITH THE POLICY PROVISIONS..
<br />Santa Ana, CA 92701
<br />AUTH,.O�RII,ZEDDREPRESENTATIVE
<br />ACORD 25 (2016103) @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered (marks of ACORD
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