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ACa b' CERTIFICATE OF LIABILITY INSURANCE
<br />4---^''
<br />- DATE (MMIDDNYYYI
<br />10/7/2015
<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 pollcy(los) 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 />Arthur J. Gallagher & Co.
<br />Insurance Brokers of CA, Inc. LIC # 0726293
<br />505 N Brand Blvd, Suite 600
<br />CONTACT Annie Lee
<br />818-539-2300. " _ I,V� c, ypl. 818-539 2301,
<br />EMANo,Exu.
<br />MAIL Annie_Lee a co
<br />aoaa@ 19� m
<br />......._.-....-..__
<br />INSURER(SI AFFORDING COVERAGE
<br />�...-......__..__...
<br />NAIGB
<br />Glendale CA 91263
<br />INSURER A: Non Profits United
<br />DAMAGE YZFRENTC9
<br />PREMISES L_occurt nre
<br />... ._---__.."_ _.______ .____._,_-
<br />wsuREo
<br />INSURERS: Great Amencan Insurance Company
<br />16691
<br />Orange County Conservation Corps
<br />1853 N. Raymond Ave.
<br />Anaheim, CA 92801
<br />INSunm c:Great American Alliance Insurance C
<br />126832
<br />............._..-.
<br />INSURER o _Hanover Insurance Compal„
<br />-_..
<br />122292
<br />_...._...-..I.
<br />INSURER E:I--
<br />_
<br />.. _ .
<br />___...__
<br />gqf-$7MM/$3MM
<br />_._.....................—._._........,�:
<br />INSURER F:
<br />_--..-.-......—
<br />COVERAGES CERTIFICATE NUMBER' 1434253951 RPVI9Ir1N 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 VV1TH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL 'rHE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR ADDE SU POLI __ POLICY__S_
<br />LTR TYPE OF INSURANCE I N POLICY NUMBER MM/OUIYYYY MMIDDM'Y LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CIAIMS-MAGE OCCUR
<br />Y
<br />PAGS603794
<br />i0/V2015
<br />101112016
<br />EACHOCCURRENCE
<br />$1.000000
<br />DAMAGE YZFRENTC9
<br />PREMISES L_occurt nre
<br />000
<br />„___,
<br />_
<br />MEO E%P (Any ono arson
<br />.5100
<br />55,000
<br />___...__
<br />gqf-$7MM/$3MM
<br />. X
<br />PE ISONAL&ADV tJURY
<br />_ _ _—_
<br />%1.000000
<br />I. AGGREGATE LIMIT APPLIES PER:
<br />PRO-
<br />GENERAL AGGREGATE$2,000000
<br />_
<br />GEN
<br />___ .- ___----- ......
<br />_
<br />POLICY ,._.i JECT LOC
<br />PRODUCTS "COMPIOP AGG
<br />51;00000tl
<br />..5
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />CAP0991249
<br />10/1/2015
<br />10/1/2016
<br />EB nccidenl _," _
<br />$1.000,000
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />1 s
<br />PXXI
<br />ALL OWNED g8HEDULED
<br />AUTOS AUTOS
<br />NON-HIREDAUTOS X AUTOS MEO
<br />T
<br />T
<br />aODI LY INJURY (Pera dem)
<br />S '
<br />PROPENPP6AMAGE
<br />Por acc!denlj-„
<br />$
<br />Comp5100 X Coll $500
<br />$
<br />C
<br />X
<br />UMBRELLA LIAR
<br />OCGUR
<br />UMB 5603795
<br />110/1/2015
<br />70/i/2010
<br />EACH OCCURRENCE
<br />52,0)D000
<br />EXCESS LIAB
<br />CLAIMBMADE
<br />..�........-
<br />AGGREGATE
<br />.............._
<br />52,000,000
<br />I DED x RETENTION $10,000
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YINr
<br />ANYPRGPRIETDRI EXCLUDRIE%ECUTIVE ❑'NIA
<br />OFFIC2JOPRI 6ERE%OLUDED7
<br />(Mandatory In NH)
<br />!
<br />NPU -WCC 001-2015
<br />11/1/2015
<br />1
<br />7/7!2016
<br />!
<br />PERITF
<br />X �,S, TATUTE ER
<br />E.L EACH ACGIDF.NT
<br />1$1,000000
<br />E.L. DISEASE . EA EMPLOYEE
<br />51,000,000
<br />It yyes, describe under
<br />E.L. DISEASE -POLIC—x$1,0 Y LIMIT
<br />--
<br />151, 000, 000
<br />DESCRIPTIOIJOFOPERATION5below
<br />D
<br />Electors & Officers
<br />I
<br />LH3 9817317 03
<br />10/1/2015
<br />10!712016
<br />!Each Clalm $2,000,000
<br />DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (ACORD 101, Addlfl ml Remarks Schedule, maybe attached it more space Is required)
<br />The City of Santa Ana, its officers, agents, employees and volunteers, and the State of California, its officers, employees, and volunteers are
<br />named additional insured/Funding Source with respect to the operations of the named insured per the attached CG 2026 e dorseme t. Such
<br />insurance is Primary and Non -Contributory, Workers Compensation coverage excluded, evidence only, e �
<br />City of Santa Ana, Workforce Investment Board
<br />1000 E. Santa Ana Blvd,, Ste, 200
<br />Santa Ana CA 92701 USA
<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 />17
<br />tICO]���t�ittV�.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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