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A� O® CERSICATE OF LIABILITY INSURACE
<br />DATEtMMIDOIYYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />05/23/2018
<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(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 lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT Nilda Garcia
<br />NAME:
<br />Hays Companies
<br />PHONE (909)243-8111 FAX
<br />AIC Na E#: AIC No:
<br />4200 Concours, Suite #350
<br />E-MAIL scornarc
<br />D ia ha antes. Com
<br />ADDRESS: g y p
<br />INSURERS) AFFORDING COVERAGE NAIC#
<br />Ontario CA 91764
<br />INSURERA: Arch Insurance Company 11150
<br />INSURED
<br />INSURER B: Cypress Insurance Company 10855
<br />Boys & Gids Clubs of Central Orange Coast
<br />INSURER C:
<br />17701 Cowan, Suite Ijo
<br />INSURER D:
<br />INSURER E:
<br />MED UP (Any one person) $ 20,000
<br />Irvine CA 92614
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: CL1852360822 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTH E 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 />ADDLSUbK
<br />INSD
<br />MD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />EACH OCCURRENCE $ 1,000,000
<br />E T D 1,000,000
<br />PREMISESDAMAGE Eaoccwrence $
<br />Professional Llabllty
<br />-
<br />MED UP (Any one person) $ 20,000
<br />X Sexual Misconduct
<br />PERSONAL a ADV INJURY $ 1,000,000
<br />A
<br />Y
<br />AAPKGO028800
<br />02/11/2018
<br />02/11/2919
<br />GEN'LAGGREGAYE LIMITAPPLIES PER:
<br />POLICY � JECT LOC
<br />GENERALAGGREGATE $ 3,000,000
<br />- -
<br />PRODUCTS-COMPIOP AGO $ 3,000,000
<br />SEXUALABUSE COV s 1,000,000
<br />OTHER'.
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT $ 1,000,000
<br />Ea accitlart
<br />BODILY INJURY (Per person) $
<br />ANYAUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />AAAUT0028800
<br />02/11/2018
<br />02/11/2019
<br />BODILY NJURY(Peraccidenq $
<br />HIRED NON-ONMEO
<br />AUTOS ONLY AUTOS ONLY.
<br />-
<br />PROPERTY DAMAGE $
<br />Per accident
<br />Medical payments $ 5,000,000
<br />UMBRELI-ki
<br />OCCUR
<br />EACH OCCURRENCE $ 5,000,000
<br />A
<br />EXCESS LIAR
<br />CLAIMS-MAOE
<br />AAFXS0028800
<br />02/11/2018
<br />02/11/2019
<br />AGGREGATE 5
<br />DED .RETENTION $ 10,000
<br />s
<br />WORKERS COMPENSATION
<br />PER OTH-
<br />B
<br />AND EMPLOYERS' LIABILITYY
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />IMandatmy in NH)
<br />If yea, doacnba under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />BOWC914957
<br />06/01/2018
<br />06/01/2019
<br />STATUTE ER
<br />E. L. EACHACCIDENT $ 1,000,000
<br />E.L_. DISEASE -EA $ 1,000,000
<br />E. L. DISEASE -POLICY LIMIT $ 1,000,000
<br />A
<br />Property RIC: Spat Form
<br />AAPKG0028800
<br />02/11/2018
<br />02/11/2019
<br />-
<br />Blanket BPP', $1,011,000
<br />Deductible', $1,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Add ltlanal Remarks Schedule, maybe attached if mare space is required)
<br />City of Santa Ana, Community Development Agency is Additional Insured; With respect to claims arising out of the operations and uses
<br />performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or
<br />contributing with any other insurance carried by or for the benefit of the additional insureds; Primary & Non -Contributory wording applies,
<br />CERTIFICATE HOLDER CANCELLATION
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Are, Community Development Agency
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, M-25
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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