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AC V CERTIFICATE OF LIABILITY INSURANCE
<br />lla .'
<br />FTATE(MM/oon•YYY)
<br />10/1/2018
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed,
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder In lieu of auch endorsements .
<br />PRoouceR
<br />Arthur J. Gallagher & CO.
<br />Insurance Brokers of CA. LIC. # 0726293e.
<br />505 N Brand Blvd, Suite 600
<br />NAME Annie Lee
<br />PHONE , g16,53g.8601 Nc No : 818.639.8701
<br />do Rees Annie Lee a .com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC9
<br />Glendale CA91203
<br />INSURERA: Great American Alliance Insurance Co
<br />26632
<br />INSURED ORANCOU•19
<br />Orange County Conservation Corps
<br />1853 N, Raymond Ave,
<br />Anaheim, CA 92801
<br />INSURER E: Great American Insurance Company of NY
<br />22138
<br />IN$URERC: NonProfits United
<br />INSURERD: Navigators Insurance Company
<br />42307
<br />INSURER E:
<br />INSURERF:
<br />COVERAGES CERTIFICATE NUMBER: 687467771 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 I$ SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />TYPE OF INSURANCE
<br />A
<br />POLC NU BE
<br />POLDUYeFF
<br />POLICY E%P
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />PA0515400014
<br />10/12018
<br />10112019
<br />EACH OCCURRENCE
<br />51,000,000
<br />CLAIMS -MADE OCCUR
<br />AI E Eaaccurra a
<br />$100,000
<br />MED E%P (Any one person)
<br />$5,0D0
<br />PERSONAL& ADV INJURY
<br />$100g000
<br />GEN'L AGGREGATE LqIIM IT APPLIES PER:
<br />GENERALAGGREGATE
<br />$3,000,000
<br />PRODUCTS - COMPIOP AGG
<br />$3,000,000
<br />%t POLICY❑jECT ❑LOC
<br />$
<br />OTHER'
<br />S
<br />AUTOMOBILELMIBILITY
<br />CAP090124006
<br />10/1201e
<br />10r112019
<br />COMEINEOSN EL
<br />Ee acCldert
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X ANYAUTO
<br />BODILY IMURY(Per acoldenl)
<br />$
<br />AUTOS ONLY AUTOSULED
<br />X HIRED X AN
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY —DAMAGE -
<br />$ '
<br />$
<br />)t Cam $100 X coil$500
<br />1
<br />A
<br />X
<br />UMSRELLAUAB
<br />X OCCUR
<br />UMS 65037UB 14
<br />10/1ama
<br />10/1/2019
<br />EACH OCCURRENCE
<br />$4,000,000
<br />AGGREGATE
<br />$4,000.000
<br />E%CESS LWB
<br />CLAIMS&1ADE
<br />DEC)
<br />I X I RETENTION&
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYFROPRIETCWPARTNER/EXECUTIVE r-
<br />NPU-VJCG001-2018
<br />1/11201B
<br />1/1/201g
<br />o
<br />X STATUTE ERH
<br />E.L. EACH ACCIDENT
<br />$1000000
<br />E.L. DISEASE -EA EMPLOYE
<br />$1,000,000
<br />OFFICER/MEMBEREXCLUDED9
<br />(Mandatory In NH)
<br />NIA
<br />E.L. DISEASE -POLICY LIMIT
<br />310o0,000
<br />If yes, absentia antler
<br />DE8 RIPTION OF OPERATIONS CeIaN
<br />❑
<br />oiredore&Creers
<br />NYI BDOLV0S181NV
<br />10/12018
<br />10I1/2019
<br />Per Claim:
<br />Aggregate:
<br />$$000,000
<br />82,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is Pinched)
<br />Policy :Abuse and molestation Coverage
<br />Policy #: PAC 61546S0 14
<br />Carder:GreatAmedcan Alliance Insurance Co, NAIC: 26832
<br />Term: 10/01/2018-10/01/2019
<br />Each Occ : $1,000,000
<br />Aggregate:$3,000,000 - Reviewed by Audrey Goodso Page_L of
<br />Policy: Professional Liability
<br />See Attached...
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />Cittyy of Santa Ana, Workforce Investment Board
<br />1000 E. Santa Ana Blvd., Ste. 200
<br />Santa Ana CA 92701
<br />All rights reserved.
<br />ACORD 26 (2D16103) The ACORD name and logo are registered marks of ACORD
<br />
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