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ACCORH CERTIFICATE OF LIABILITY INSURANCE
<br />9/19E(MMI Dom)
<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(ies) 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 ri hts to the certificate holder in lieu of such endorsements .
<br />PRODUCER
<br />CIBC Insurance Services LLCPHGNE
<br />License #OK19767
<br />Old Slip
<br />CONTACT
<br />NAME: Carrie Clark
<br />310-981-0801 FAX
<br />. carrie.clark@crystalco.com
<br />R,,%rrie�.clark@crystalco.com
<br />INSUREll AFFORDING COVERAGE NAIC #
<br />New York NY 10005
<br />INSURER A:Alllance of Nonprofits for Insurance, R 10023
<br />INSURED BIGBRO1
<br />INSURER B:Technolo y Insurance Company, Inc. 42376
<br />Big Brothers Big Sisters of Orange County
<br />dba: Big Brothers Big Sisters of the Inland Impire
<br />8880 Benson Ave, Ste. 112
<br />INSURER C:
<br />INSURER 0:
<br />E
<br />Montclair CA 91763INSURER
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 1803801215 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 />rypE OF INSURANCEADDLSUBR
<br />INSD
<br />WVD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIODM'YY
<br />POLICY EXP
<br />MMIDDA`YYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIALGENERAL LI ABILITY
<br />Y
<br />20170647ONPO
<br />2/11/2017
<br />2/11/2018
<br />EACH OCCURRENCE $1,000,000
<br />CLAIMS -MADE � OCCUR
<br />PREMISES Ea occurrence $500,000
<br />MED EXP An one person) $20,000
<br />PERSONAL &ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $3,000,000
<br />POLICY PEC LOC
<br />PRODUCTS-COMP/OPAGG $3,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />20170647ONPO
<br />2/11/2017
<br />2/11/2018
<br />Ba mmi Ut N LE LIMIT
<br />$1,000,000
<br />BODILY I NJU BY (Per person) $
<br />AUTO
<br />AUTOS ONLY AUTOSULED
<br />BODILY INJURY (Per accident) $
<br />XANY
<br />XJ
<br />HIRED NON -OWNED
<br />AUTOS ONLY X AUTOS ONLY
<br />PROPERT -DAMAGE
<br />Per accident $
<br />A
<br />X
<br />UMBRELLA LIAB
<br />OCCUR
<br />201706470UMBNPO
<br />2/11/2017
<br />2/11/2018
<br />EACH OCCURRENCE $3,000,000
<br />AGGREGATE $3,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED 'X I RETENTION$ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />TWC3613860
<br />2/11/2017
<br />2/11/2018
<br />X PER OTH-
<br />STATUTE ER
<br />E. L. EACH ACCIDENT $11000,000
<br />ANY PROPRIETORIPARTNERIEXECUTIVEF7NIA
<br />OFFICER/MEMBER EXCLUDED?
<br />E. L. DISEASE - EA EMPLOYE $1,000,000
<br />(ManJatory in NH)
<br />If Yes, describe under
<br />DE Ins,OF OPERATIONS below
<br />E. L. DISEASE - POLICY LIMIT $1,000,000
<br />A
<br />Liquor Liability
<br />201706470NP0
<br />2/11/2017
<br />2/11/2018
<br />Limit: $1,000,000
<br />Improper Sexual Conduct Limits
<br />Limit: $1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Sch could, may be attached If more space Is required)
<br />Re: CDBG Agreement
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as Additional Insured as required by written
<br />contract as respects General Liability coverage per attached endorsement form no. CG20260413. Coverage is primary and non-contributory
<br />per attached endorsement form no. NIAC-E611215.
<br />✓01J�?`'✓i°s
<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 />City Of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza, M-25
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />Ord C 7rrA tiS,.m C;L ,eri-ln+,.rY.OGA.. LLC
<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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