COMMUNITY HEALTH INITIATIVE OF ORANGE COUNTY-2017

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CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIVYYY) 7/20/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME: Certificate Issuance Team Comprehensive Insurance Services 26429 Rancho Parkway South AIC NNo Ext: (949) 709-8800 qAC No: (949)709-1668 AIL ADDRESS: info@thecomprehensiveinsurance.com INSURER(S) AFFORDING CCVERAGC MAIC Suite 120 Lake Forest CA 92630 INSURER A:Non rofits Ins Alliance of CA 11845 INSURED INSURER 3: CLAIMS MADE OCCURG INSURER C: Community Health Initiative of Orange County 1505 E. 17th Street, Suite 121 INSURER DI INSURER E: MEDEXP(Anyonepereon) $ 20,000 Santa Ana CA 92705 INSURER F: X COVERAGES CERTIFICATE NUMBER:GL REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BYPAID CLAIMS. ILTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MMIDDIYYYV PGLI CY E%P MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS MADE OCCURG P To RENTED 500,000 PREMISES EeocwneRep $ MEDEXP(Anyonepereon) $ 20,000 X 2016 -44927 -NPO 10/15/2016 10/15/2017 PERSONAL&ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER POLICY [::] PRO- X❑ Loc JECT GENERAL AGGREGATE $ 2,000,000 GEN'L PRODUCTS-COMP/OP AGG $ 2,000, 000 $O Deductible $ OTHER'. AUTOMOBILE _ LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea acoldent BODILY INJURY person) $ AANY AUTO ALL OVNJED SCI ]BELLED AUTOS AUTOS 2016 -44927 -NPO 10/15/2016 10/15/2017 BODILY INJURY(Peraccidenl $ ) X HIRED AUTOS X NON-CbUNED AUTOS PROPERTY DAMAGE $ Per accident) 0 Deductible $ UMBRELLA LIAB Id OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS -MADE AGGREGATE $ DEC) I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN ANY PROFRIETORIPARTNER/EXECUTIVE OFFICERNEMBER EXCLUDED? �N/A STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EAEMPLOYE $ (Mandatory in NH) V. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Social Service Professional 2016 -44927 -NPO 10/15/2016 10/15/2017 $1000000Agg/10000000m $0 Deductible A Improper Sexual Cord. Liab. 2016 -4427 -NPO 10/15/2016 10/15/2017 $1,000,00OPOS1000, OOOEa CI $0 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) City of Santa Ana, its officers, employees, agents and volunteers are included as Additional Insured automatically per written contract or agreement per attached endorsement CG2026. 30 day notice of cancellation with 10 day notice of cancellation for non-payment of premium per policy provision. This insurance is Primary and Non-contributory per attached endorsement NIAC E61. City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE -"7 chard Eynon/JEREMY ACORD CORPORATION. All rinhte reeervmd. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD I NS025 (201401)