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ntr 141511110 0 K0111 <br />A LX CERTIFICATE OF LIABILITY INSURANCE <br />DAT5Yt <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />o9114111a1x01 5 <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 0048 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 endorsements). <br />PRODUCER <br />Fullerton Insurance Sarv" <br />CONTACT <br />NAME: t:ommeYClai Linea DaIS - <br />CDI110596796 <br />CDI0x <br />atco 794-ST7.5800 I tate Nor, 794.447.00'11 <br />4054 <br />Fullerton, CA 92834.4054 <br />E -Man <br />ADOA88; rec fullertonlnsurance.com <br />._........__... <br />INSURER1a7AFFarwrm ccvERACE <br />NAiCN <br />Leslie A. McCarthy, CIC <br />GENT. AGGREGATE LIMIT APPLIES PER: <br />INSURER A, Non rofltelns,AllianceofCA <br />GENFRALAGGREGATE $ 2,000,0110 <br />INSURED Women's Transitional Living <br />INSURER 3: New York Marine & General Ins. <br />16608 <br />Center Inn. <br />INSURER C ; <br />PRODUCTS - COMPIOP AGG $ 2,000,000 <br />P.O, Box 916 <br />Fullerton, CA 92832 <br />INSURER D <br />AUTOMOBILELIARILRY <br />_INSURER E. <br />A X ANY AUTO <br />201601835NPO 09101/2015 <br />INSURER F, <br />ALL OS <br />UTOSSCHEDLEO <br />UTOS <br />COVERAGES CERTIFICATE NUMBER: RrviAlow NUMRFa• <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 />IYSRL,A' TYPEOFINSURANCFWOL <br />POLICYNUMBER <br />Community Development Agency <br />N X COMMERCIAL GENERAL LIABILITY <br />Daniel Perez <br />EACH OCCURRENCE $ 1.000,00 <br />CLAUJS MADE %t OCCUR <br />x 01501885NPO 0970172015 <br />0910112010 DAM T -..-.....-. <br />FREMIaEE Ea «xrir $ 500,00 <br />.... <br />MEO E%P AnYana person) $ 20,00 <br />PERSONAL&ADVINJURY $ 1,000,000 <br />GENT. AGGREGATE LIMIT APPLIES PER: <br />GENFRALAGGREGATE $ 2,000,0110 <br />x <br />El <br />................. <br />POLICYjCOT LOC <br />PRODUCTS - COMPIOP AGG $ 2,000,000 <br />OTHERS: <br />$ <br />AUTOMOBILELIARILRY <br />CEOMBINSINGI.E LIMIT <br />a a cltl F..D$ 11000,000 <br />A X ANY AUTO <br />201601835NPO 09101/2015 <br />09101/2016 BODILY INJURY (Per Person) $ ................. <br />ALL OS <br />UTOSSCHEDLEO <br />UTOS <br />BODILY INJURY Per accident) $ <br />( <br />NON -OWNED <br />x 411RE0 AUTOS AUTOS <br />--- HIRED <br />41000coll <br />_ <br />PROPERTY DAMA E <br />Per accitlenl <br />$500 Comp <br />x UMBRELLA LIAR x OCCUR <br />EACH OCCURRENCE 1§ 5,000,00 <br />A ExDEss UAB CLaIMSMADF <br />0150183SUMBNPO 09101[12015 <br />0910112016 AGGREGATE -$ 51000,04 <br />DOE) I RETENTION$ <br />g <br />WORKERS COMPENSATIONPER <br />X CRH <br />AND EMPLOYERS' LIABILITY YIN <br />STATUTE R <br />B ANY PROPRIETORWARTNERJEXECU7VE <br />WC201500005441 03!20/2015 <br />MIA <br />03/2012016 E.L. EACH ACCIDENT 1,000,00 <br />OPFICERMEINBER EXCLUDED? <br />(Mandatory In NH) <br />...--_----...—._ .. ... ....................._,__._,_.� <br />EL. DISEASE - EA EMPLOYE '$ 11000,000 <br />SIaIIP OPTON OFOPERRTIONS b010W <br />E.L. DISEASE -POLICY LIMIT $ _— 11000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD101,Additional RamarkaSchedule,maybealtaairedif,m,roepo oIsrequlred) <br />City of Santa Ana, its c££ieers, ageata employees and volunteers are named <br />as additional inouseds as respeote to theggeneral liability policy limits <br />andorsoment CO2C12 to the <br />per attached poli.oy with coverage primary and <br />XXACE61 <br />non-contributory per endorsement attached to the pol ey. <br />d �W, 77'r <br />" V <br />CERTIFICATE HOLDER CANCFI_I ATION <br />CISANBE <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana-ESG M-25 <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Community Development Agency <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Daniel Perez <br />-- <br />AUTHORIZED REPRESENTATIVE <br />P.O. Box 1980 M-25 <br />Santa Ana, CA 92702 <br />©1988-2014 ACORD CORPORATION. All rights ressrvod. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />