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ILLUFOU-01
<br />MWOODS
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />_
<br />DATDIYYYY)
<br />100/4!2/412016
<br />THIS CERTIFICATE IS ISSUED ASA 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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 0 0079613
<br />NONTACT
<br />Bowermaster & Associates Insurance Agency, Inc.
<br />10806 Holder Street, Suite 350
<br />Cypress, CA 90630
<br />r
<br />I ( ) 733-6200
<br />uc °, No, Ext; 714 luc, Nol:(714) 252-8253
<br />E.MAII�s
<br />INSURER(SI AFFORDING COVERAGE NAICp
<br />INSURER A: Nonprofits' Insurance Alliance of California
<br />X
<br />I COMMERCIAL GENERAL LIABILITY
<br />INSURED IllumINSURER
<br />2691 Richienation Foundation
<br />2891 Richter Avenue
<br />B:West American Insurance
<br />44393
<br />INSURER C:
<br />INSURERD:
<br />S 1,000,000
<br />Suite 107
<br />INSURER E
<br />X
<br />Irvine, CA 92606
<br />INSURER F :
<br />09/1512016
<br />09/15/2017
<br />COVERAGES CERTIFICATE NUMBER- RCV1cION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE. POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTIMTH RESPECTTO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED. BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THETERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />INSR
<br />t IS
<br />TYPE OFINSURANCE
<br />ADDLSUBR
<br />me
<br />POLICY NUMBER
<br />IMOMLIMITS
<br />0
<br />A
<br />X
<br />I COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />CLAIMS -MADE [�] OCCUR
<br />X
<br />201624712NPO
<br />09/1512016
<br />09/15/2017
<br />OAMAGEj=ED
<br />500,000
<br />on e
<br />S
<br />MED EXP(Nn„yoneosson
<br />5 20,000
<br />PERSONAL&AOV INJURY
<br />S 1,000,000
<br />GENL AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />3,000,000
<br />X POLICY ❑ PRO' LOC
<br />JECT
<br />PRODUCTS-COMPIOPAGG
<br />S 3,000,000
<br />S
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />JOE
<br />$ 1,000,000
<br />X
<br />ANY AUTO
<br />BAW56316571
<br />09115/2016
<br />09/1612017
<br />BODILY INJURY Per erson
<br />--_.
<br />5
<br />OWNED SCHEDULED
<br />AUpTEOS ONLYqAUOoTOS
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<br />e001LYINJURY Peraecident,
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<br />AUTODS AUTNO� ON4B
<br />1PeFP% nIDAMAGE
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<br />5
<br />A
<br />X
<br />UMBRELLA LIAR X OCCUR
<br />EACH OCCURRENCE
<br />—S
<br />3 2,000,000
<br />use CLAIMMADE
<br />201624712UMBNPO
<br />09M6/2016
<br />09115/2017
<br />----FS-2,000,000
<br />DECOED X RETENTIONS 10,000
<br />AGGREGATE—__
<br />S �2,OOQ000
<br />5
<br />EERS COMPENSATIONILII
<br />PER s OTH
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<br />AND
<br />AND EMPLOVERS'LIABILITY VIN
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<br />SI ATUTE
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<br />EXCLUDED? LL �'
<br />IMFandatory In UP,
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<br />If yes, describe under
<br />E.L. DISEASE -EA EMPLOYEE'
<br />8
<br />DE SCRIPTION OF OPERATIONS below
<br />I__
<br />E.L. DISEASE -POLICY LIMIT
<br />5
<br />A
<br />Professional Liabili
<br />-201624712NPO
<br />1 09116/2016
<br />09115/2017
<br />Oce. $1,000,0001Agg
<br />3,000,000
<br />A
<br />Improper Sexual Cond
<br />201624712NPO
<br />09115/2016
<br />99/1512017
<br />Occurrence/Agg
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD Wi, AddltionM Remarks Sdtedule, moy bo attached if more space is regglmdl
<br />RE: HPRP Contract 8A-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 0000010798,
<br />f
<br />City of Santa Ana
<br />20 Civic Center Plaza, M-26
<br />Santa Ana, CA 92701
<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 />FwVrtu <O I<V Iglwof U 1988-'LU15 ACURD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
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