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06/19/2018
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25H - AGMT - YOUTH PROVIDERS
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Last modified
6/19/2018 10:24:34 AM
Creation date
6/14/2018 7:57:29 PM
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City Clerk
Doc Type
Agenda Packet
Agency
Community Development
Item #
25H
Date
6/19/2018
Destruction Year
2023
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FXHIRIT 1 <br />CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIWYY) <br />05/00/2018 <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 INS URER(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 />PRODUCER <br />CONTACT <br />NAME; CerflFlcate Issuance Teem <br />Comprehensive Insurance Services <br />AHre°NN (949) 709-8800 Na (848) 708-1668 <br />26429 Rancho Parkway South <br />a DD REss; Infogthecompmhensive nnsumnce.com <br />Suite 120 <br />INSURERIS) AFFORDING COVERAGE NAICN <br />Lake Forest CA 92630 <br />INSURERA: Nonprofits Insurance Alliance of California 11845 <br />INSURED <br />INSURER B: <br />Orange County Children's Therapeutic Arts Center <br />INSURER C: <br />_ <br />2215 N. Broadway <br />INSURER D; <br />INSURER E! <br />Santa Ana CA 92706 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: Lm7122203108 RFVISIONNIINUiPR- <br />THIS ISTO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDA13OVE 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 MAYBE 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 />IY <br />LTR <br />TYPEOFINSURANCE <br />SD <br />4WD <br />POLICY NUMBER <br />MMID�IYYYY LICY EFF <br />EXP <br />MWDO <br />LIMITS <br />X1 COMMERCIAL GENERAL UANLITY <br />CLAIMS -MADE 7X OCCUR <br />EACH OCCURRENCE $ 1,000,000 <br />PREMISES EaeeW arse $ 500,000 <br />MEDEXP("ane on) $ 20,000 <br />PERSONAL A ADV INJURY $ 1,000,000 <br />A <br />Y <br />2017-092D1 <br />12/2112017 <br />12/21/2018 <br />GEN'LAGGREOATE LIMIT APPLES PER: <br />POLICY ❑ JECT � LOC <br />GENERALAGGREGATE s 2,000,000 <br />PRODUCTS $ 2,OOD,000 <br />OTHER: <br />$0 Deductible s <br />AUTOMOBILE <br />LIABILITY <br />COMBINEDSINGLEUMIT $ 1,000,000 <br />Es acGtle 1 <br />ANYAUTO <br />BODILY INJURY (Per person) s <br />AOWNED <br />IX <br />SCHEDULED <br />AUTOS ONLY AUTOS <br />2017.09201 <br />12!2112017 <br />12/21/2018 <br />BODILY NQ URY(Per actldent) $ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />racddnt s <br />$O Deductible $ <br />UMBRELLA LIAR <br />OCCUR <br />EACHOCCURRENCE s <br />AGGREGATE $ <br />EXCESS UAB <br />CWMS-MADE <br />DED I I RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'UABILITY YIN <br />ANY PROPRIETORIPARTNEWEXECUTNE <br />OFFICER/MEMBER EXCLUOEDT <br />MIA <br />I PER OTH- <br />6TAME ER <br />E.L EACH ACGDENT $ <br />E.L. DISEASE - EA EMPLOYEE $ <br />(Mandatory In NH) <br />N yes, describe under <br />E.L. DISEASE -POLICY LIMIT 8 <br />DESCRIPTION OF OPERATIONS below <br />A <br />Social Service Professional Liability <br />Improper Sexual Conduct Liability <br />2017-09201 <br />1212112017 <br />12/21/2018 <br />$1,000,000/1,000,000 Aggregate/Occurr <br />$1,000,000/1,000,000 Aggregate/Occurr <br />$0 Deductble <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddlUOnal Remarks Schedule, maybe aOachOd It MON BpaCO IB roqulred) <br />The City of Santa Ana, its officers, employees, agents, and representatives are Included as Addidonal Insured per attached endorsement CG2026. With <br />respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy Is <br />primary and is not additional to or Contributing with any other insurance carried by or for the benefit of the additional insureds per attached endorsement <br />NIAC 1161. 30 day notice of cancellation with 10 day notice of cancellation for non-payment of premium per policy provision. <br />CERTIFICATE HOLDER r.ANr PI I ATInhi <br />6H 4O ©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name a w 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 Ana (The) <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92702 <br />w <br />6H 4O ©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name a w marks of ACORD <br />
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