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CERTIFICATE OF LIABILITY INSURANCE I <br />DAAE(MM'DD/^eYY) <br />THIS CERTIPICATE I$ ISSUED AS A MATTER OF INPORMATION 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(los) 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 />Arthur J. Gallagher & Co. <br />Insurance Brokers of California, ]no, LICO 0726293 <br />1255 Battery Street#450 <br />San Francisco CA 04111 <br />INSURED <br />Orange County Conservation. Corps <br />1863 North Raymond Avenue <br />Anaheim, CA 92001 <br />CERTIFICATE NUMBER:101310791 <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 WHJOH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 1.0 ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />IN_,�.__ ._. _. _.u.... .__.. _,__....__.__ ACiBL 114 .._......._,._.-...... _� ., _.__,_._.. pSLTCY—.. Parg_gp_.. <br />.....__.,__ . ... _......_,-..___�_,._......._ <br />TNPE DP INEURANRE P UCYNUMOCR Y <br />LIMBS <br />COMMERCIALOENERjAL LIABILITY <br />EACH OCCURRENCE <br />OfiNTAC;CTO�ffiNT€0-- --_...-- <br />CLAIMS -MADE l _l OCCUR <br />_PHSMII�E&,(,E.asagvna�lcsl _ . __ .... <br />MED EXP �Any.OnO.paf6an)_. _. _�..._.....__....._...--- „__ - <br />PERSONAL&Ap41NA) <br />GEML AGGREGATE LIMIT APPLIES PER; <br />AGGREGATE .� <br />p0. _ r <br />_ POLICY L._.1 JECT LOC <br />_GENERAL _ _ _. <br />PPQ�41CT9 •,CQMP/bP AOG _I!_...__.�.. �___.._ <br />OTHER: <br />S <br />AUTOMOSILELIABILITY <br />_. <br />.CvIBINGIDSiNGLEUMITS <br />ANYAVTO <br />BODILY INJURY IPer person) <br />0 <br />90HEOULEO <br />AUT08 ONLY <br />BODILY INJURY(PanrAldent) <br />1 - - <br />' <br />HIRED NON-0WNEU <br />PROPER7YpAMAi�II.� <br />AUTOS ONLY AUTOS ONLY <br />fPAr Aagldenf)_._ <br />E <br />UMBRELLA LIAR OCCUR <br />CACM OCCURRENCE _:S_._...__._. <br />EXCESS LIAR CLAIMS -MADE <br />AGGREGATE <br />S <br />)ED RETSINTIONS <br />A <br />WORKERS COMPENSATION <br />NPU. WOG 001.2019 <br />111I2970 <br />V112020 <br />X 7H <br />la`iTA.T47€.. PE <br />AND EMPLOYERTUADILISY <br />YD <br />_._ .�,__ ........_ <br />ANYPRCPRIETCIVPARTNER/EXECUTIYE <br />EI BAC4IACCIDENT <br />Stl0000 <br />OFFIOERIMEMaE%EXGLOUED4 <br />NIA <br />_S <br />(Mandatory In NN) <br />E.L.DISEASE, EA EMPLOYE <br />...r.............�.___........_.. <br />$500,000 <br />.._.,_.._..._..,__.._—_— <br />If s, desonbe under <br />D C P FOPER TION I W <br />G.L. DISEASE - POLICY'LIMIT <br />6500000 <br />e Fmoss Woktrs' Camp 8P4069671 111121111 11111111 <br />Umltper Occu moe BlatWory <br />EL Per Om&Agg 2.000,000 <br />XS of 6001001) <br />OBSCRINTIGNOFOPERArIONSILOCAnONSIVEHIOLFS (ACORD 101, Addlllohal Romm'ke Schedule, may Do atterlhsdlf more space is murmured) _ <br />�rr <br />l <br />_._ <br />C`ERTIRICATE HOLDER CANCELLATION <br />SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Santa Ana Workforce Investment Board <br />THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />Fran Jutzl <br />1000 Fast Santa Ana Boulevard <br />Santa Ana CA 92701 <br />AU HORIZED REPRESENTATIVE <br />i frur <br />C 1988.2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />202 3476 <br />