LUTHERAN SOCIAL SERVICE OF SO. CAL. (2)

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vk� ry CERTIFICATE OF LIABILITY INSURANCE 02/20/2020m 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(ies) must have ADDITIONAL INSURED provisions or 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 LIC #UB29370 1-925-682-7001 Edgewood Partners Insurance Cents! 2300 Contra Costa Blvd CONTACT Melissa Davis NAME: PHONE 925-652-0436 AI Ezt: aC No: 925-852-0486 E MAILADDRESS: Melisea.Davis®epicbrokers.com Suite 375 Pleasant Hill, CA 94523 INSURERS AFFORDING COVERAGE NAIC9 INSURERA: REDWOOD FIRE & CAS INS CO 11673 INSURED Lutheran Social Services of Southern California INSURER B INSURER C : 435 W. Orange Show Lane, Suite 104 INSURER D: INSURER E : San Bernardino, CA 92408 INSURER F: r�G rrJN1Y tYU1YlOCR: 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADO SUBR LTR TYPE OF INSURANCE PODCYNUMBER POLICY EFF POLICYEXP MM/DD/YYYY MM/Yp LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ AMA RE ❑ PREMISES Ea occurrence $ MED EXP(Anyone parson) $ PERSONAL &AOV INJURY $ GEML PI AGGREGATE LIMIT APPLIES PER: ECT OC POLICY PRO- ❑ OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY EOMHtNLO SINGLE LIMIT a accident) $ BODILY INJURY (Per person)) $ BODILY INJURY(Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE g OED I I RETENTION$ $ A ANY EMPLOYERS LIABILITY AND EMPLOYERS' LIABILITY YIN OFFICE IMEMB RIPARTNERIEXECUI7VE (Mandatory InN RFJCCLUDE❑7 lfandatoryb NH) D yes, tlescriba antler DESCRIPTION OF OPERATIONS below N/A LUWC114928 01/01/20 01/01/21 X PER ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1, 000, 000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of insurance coverage. REVIEWED & APPROVED By R15k MANAGEMENT DIVISION MAR 02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana Public Works Agency THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, I CA 92701 USA 5 ACORD ACUKU 25 (ZU16/03) The ACORD name and logo are registered marks of ACORD BrunyArgo SRR5117S rights reserved_