|
A D® CERTIFICATE OF LIABILITY INSURANCE
<br />Y)
<br />D7/12/2017
<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 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 />Hays Companies
<br />4200 Concours, Suite #350
<br />Ontario CA 91764
<br />CONTACT Nilda Garcia
<br />NAME:
<br />(909)243-8111 JO No:
<br />-MAIL V�a�.ia@hayscompanies.com
<br />scorn anies.com
<br />ADDRESS: g y P
<br />MESE
<br />INSURERS AFFORDING COVERAGE NAIC N
<br />INSURERA:Great American Ins. Co. of NY 22136
<br />INSURED
<br />Boys & Girls Clubs of Central Orange Coast
<br />250 N Golden Circle Suite 104
<br />Santa Ana CA 92705
<br />INSURER B:Insnrance Company of the West 27847
<br />INSURERC:
<br />INSURERD:
<br />INSURER E :
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:CL1752540536 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDDIYI'YY
<br />LIMITS
<br />Santa Ana, CA 92702-1988
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE In 1,000,000
<br />ACL-NMS-MADE1XI
<br />DAMAGE TO RENTED 100,000
<br />PREMISES Eaoccurrence $
<br />X
<br />MED ERE (Any one person) $ 5,000
<br />Professional Liabilty
<br />X
<br />PAC4614128
<br />2/11/2017
<br />2/11/2018
<br />X
<br />Sexual Misconduct
<br />PERSONAL& ADV INJURY s 1,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE $ 3,000,000
<br />X POLICY ❑LOC
<br />PRODUCTS - COMP/OP AGO $ 3,000,000
<br />SEXUAL ABUSE COV $ 1,000,000
<br />OTHER
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLELIMIT _$_1000'000
<br />Ea accident
<br />BODILY INJURY (Per person) $
<br />A
<br />X
<br />ANY AUTO
<br />ALLOWNED SCHEDULED
<br />AUTOS AUTOS
<br />CA24614129
<br />2/11/2017
<br />2/11/2018
<br />BODILY INJURY(Peraccident) $
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE $
<br />Peraccident
<br />Medical Payments $ 5,000
<br />X
<br />UMBRELLA ILIAD
<br />OCCUR
<br />EACH OCCURRENCE $ 5,000,000
<br />AGGREGATE $
<br />A
<br />EXCESSLIAB
<br />CLAIMS -MADE
<br />DED X RETENTION$ 10,000
<br />$
<br />131,184614130
<br />2/11/2017
<br />2/11/2018
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />X PER 'ER'_
<br />STATUTE ER
<br />E.L. EACH ACCIDENT $ 1 000 000
<br />B
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, tleecdo. under
<br />WVE 5033839 02
<br />6/1/2017
<br />6/1/2018
<br />E. L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />E, L. DISEASE -POLICY LIMIT $ 1,000,000
<br />A
<br />Property R/C: Spcl Form
<br />E
<br />PAC4614128
<br />2/11/2017
<br />2/11/2018
<br />Blanket BPP',$876,000
<br />Deductible', $1,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />*30 days Notice of Cancellation except 10 days for non-payment; City of Santa Ana Community Development
<br />Agency, its officers, agents, employees, and volunteers are Additional Insureds; Primary &
<br />Non-contributory applies to the cert. holder;
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2014/01)
<br />INS025 PJn14n11
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Community Development Agency
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />(M-25)
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />P.O. Box 1988
<br />Santa Ana, CA 92702-1988
<br />_
<br />W Mershon/NGARCI
<br />ACORD 25 (2014/01)
<br />INS025 PJn14n11
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|