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A� O® CERTIFICATE OF LIABILITY INSURANCE <br />DATE/1M/2pOmYY) <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 In Ileu of such endorsement(s). <br />PRODUCERp <br />Bolton &Com an <br />3475 E. Foothill Blvd., Suite 100 <br />Pasadena, CA 91107 <br />CONTACT <br />NAME: <br />PHONE— FAX <br />ANC Nst 626 799-7000 AIC No: 626 583-2117 <br />No <br />E-MAIL <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE NAIC4 <br />COMMERCIAL GENERAL LI ABILITY <br />INSURERA: Philadelphia Indemnity 18058 <br />www.boltonco.com 0008309 <br />INSURED <br />YMCA of Orange County <br />INSURER B: Quality Comp, Inc. 38865 <br />3/1/2018 <br />13821 Newport Avenue Suite 200 <br />INSURER C: <br />INSURER D: <br />Tustin CA 92780 <br />INSURER E, <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER' gs71laeaD REVISION NUMRFR- <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 />LTR <br />TYPE OF INSURANCE <br />ADD)_ <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />MMIDD VYXYY <br />LIMITS <br />A <br />r/ <br />COMMERCIAL GENERAL LI ABILITY <br />✓ <br />PHPK1617655 <br />3/1/2017 <br />3/1/2018 <br />EACH OCCURRENCE <br />S 1,000,000 <br />C <br />CLAIMS -MADE OCCUR <br />✓ <br />DAMAGE TO RENTED <br />PREMISES LEa occurrence)__ <br />$ 1,000,000 <br />✓ <br />MED EXP (Any one person) <br />$ 20,000 <br />Includes Sexual Abuse Coverage <br />PERSONAL &ADV INJURY <br />$ 1,000,000 <br />GEM)_ AGGREGATE LIMIT APPLIES PER: <br />GENERALAGGREGATE <br />$ 2,000,000 <br />POLICY u JECTPRO- [::] LOC <br />PRODUCTS - COMP/OP AGG <br />$ 2,000,000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILE LIABILITY <br />PHPKI617655 <br />3/1/2017 <br />3/1/2018 <br />COMBINED SINGLE LIMIT <br />Ea accident) <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />1✓ <br />BODILY INJURY (Par accitlent) <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />A <br />r/ UMBRELLALIAB <br />,/ <br />OCCUR <br />PHUB531685 <br />3/1/2017 <br />3/1/2018 <br />EACH OCCURRENCE <br />$ 15000000 <br />AGGREGATE <br />$ 15,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION$ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPMETOR/PARTNER/EXECUTIVE YIN <br />OFFICERIMEMBEREXCLUDEDP <br />NIA <br />0150820317 <br />3/1/2017 <br />3/1/2018V <br />STATUTE 0RH <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E, L. DISEASE - EA EMPLOYEE <br />$ 1,000000 <br />(ManGatoryin NH) <br />If yes, describe under <br />DESCRIPTIONOF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ 1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />GL Additional Insured applies per CG20260413 attached. GL Primary & Non -Contributory Wording applies per PIGLOO50712 attached. <br />GL Cancellation Clause applies per PICANXAICH020511 attached. <br />Branch: AO; Activity: Santa Ana Financial Assistance Program; Group: Loma Vista Childcare and SA Branch; Dates: 7/1/17 - 8/30/17. <br />Additional Insured(s): The City of Santa Ana, its officers, employees, agents and volunteers. <br />fl _ 2ibT1 e71 <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />The Ci <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City Santa Ana Commuit Development <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />A ency(M-25) yACCORDANCE <br />20 Civic Center Plaza <br />WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92701 <br />pig <br />Joyce Ferguson <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />36719649 1 17 GL AOTO EXCESS WC I Nancy Cadwallader 1 9/19/2019 4:42:13 PM (PDT) I P ge 1 of 4 <br />