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<br />ILLUFOU-01
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />MWOODS
<br />DATE (MMIDOUYYYYI
<br />07/1112017
<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 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 M lieu of such endorsoment(a).
<br />PRODUCER License # OD79613
<br />NOx�ACT
<br />Bowermaster & Associates Insurance Agency, Inc.
<br />lac°,,"l o, Ext):_(714) 733-6200 jArc, xo):(714) 252.8253_
<br />10805 Holder Street, Suite 350
<br />E-MAIL
<br />Cypress, CA 90630
<br />ADDRE _
<br />_
<br />INSURERfSI AFFORDING COVERAGE - NAIC k
<br />7
<br />INSURERA: NOnprofltS Insurance Alliance of California
<br />INSURED
<br />4
<br />INSURER s:West American Insurance _ 144.393
<br />Illumination Foundation
<br />IxsuRERc:
<br />2691 Richter Avenue
<br />—�—"
<br />Suite 107
<br />INSURER D: 1
<br />Irvine, CA 92606
<br />INSURER E: .
<br />INSURER F:
<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 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 />_
<br />(NSRADDL SUBR� POL_EXP
<br />POLICY NUMBER y)1 MM/DQ LIMITS
<br />TYPE OF INSURANCE W
<br />A
<br />X I COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,eQQ
<br />CLAIMS -MADE � XX] OCCUR X 201624712NPO 09/15/2016 09/15/2017
<br />DAMAGE TO RENTED �$ S00 000
<br />PREMISES IERp-NTED $
<br />_
<br />7
<br />�
<br />000000
<br />PERSON AL $ AW 19JURY $ 1,000,0001 020, 3
<br />UR00,77
<br />I
<br />GEML AGGREGATE LIMIT APPLIES PER: I
<br />X POLICY E] %,O F] LOC
<br />GENERAL AGGREGATE 3'000'000
<br />_._
<br />PRODUCTS - COMP/OP ,AGO $ 3rQQQAQ6
<br />OTHER:
<br />$
<br />_b_[AUTOMOBILE
<br />_
<br />LIABILITY
<br />Ee eBINED SINGLE LIMIT $ 1,000,000
<br />X1ANY AUTO BAW56316571 09/15/2016 09115/2017
<br />I BODILY INjuRY (°er,,aM , S__
<br />OWNED ACHEDULc3
<br />AUTOS ONLY AUTOS
<br />BODILY INSURYJPeraoddanit $
<br />HftMD' NANO NED
<br />ROPERSY AMAGE
<br />Petacc(dset
<br />.� ATOS ONLY AVTOS ONLY
<br />,._..
<br />.....� $
<br />A
<br />X
<br />UMBRELLALIAB X OCCUR
<br />EACHOCCURRENCE 2,Q00,000
<br />EXCESS LAB CLAIMS -MADE 201624712UMBNPO 09/15/2016 09/15/2017
<br />AGGREGATE $ 2,000000
<br />'
<br />(DED X RETENTION$ 10,000(
<br />WORKERS COMPENSATION ��— —_.
<br />AND EMPLOYERS'LWBILITY 3
<br />Y�
<br />PEft OTH-
<br />SAIVEE -EP—
<br />ANY PROPMETORtPARTNERIEXECUrIVE
<br />NTA
<br />E. L. EACH ACCIDENT
<br />ppF�fICEWMEMBER EXCLUDEDNH). _
<br />IMandatary Burd
<br />E.L. DISEASE -EAEMPLO_Y
<br />Ifyea, describe OF O
<br />pE9ORIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $
<br />A
<br />(Professional Liabili 201624712NPO 09/15/2016109/15/2017
<br />Oce. $1,000,000/Agg 3,000,000
<br />A
<br />Improper Sexual Cond 201624712NPO 09/16/2016109115/2017
<br />Occurrence/Agg 1,000,000
<br />DESCRIPTION OF OPERATIONS t LOCATIONS I VEHSCLES ((ACORD 101, AddirWaal Remarks Schedule, may ba attached If mom space is PlWred)
<br />The following endorsements apply in favor of Ctty of Santa Ana, Its officers, agents, representatives, employees and volunteers to the extent required by a
<br />written contract:
<br />General Liability: Additional Insured perform CG20260413. Primary and Non -Contributory wording applies par form NIAC-5611215. Cancellation conditions
<br />apply perform IL02700912.
<br />1}p fJFPVI:�it kdrx VV\
<br />City of Santa Ana
<br />Community Development Agency (M-25)
<br />20 Civic Center Plaza
<br />P.O. Box 1988
<br />Santa Ana, CA 92702
<br />A M1ntan 14 fInI A/All
<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 />COZkP.%b71SGIn[KM7:7rIKU7Se7 7�1YQ17. 1IIIRTS1111I7TTM- 111 1
<br />The ACORD name and logo are registered marks of ACORD
<br />
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