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2110E-00e0
<br />DATE 02(MM/2019 l
<br />o2toB/zols
<br />�1CORC�" CERTIFICATE OF LIABILITY INSURANCE
<br />�---�
<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(les) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditlons 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 such endorsement(s).
<br />ns
<br />PRODUCER 41C0e # 0564249 &a cT
<br />Heffernan Insurance Brokers - PNONE aX
<br />18004 Sky Park Circle, Suite 210 (EAIC,1p, NI,a Ext)1 1 (949) 771-3400 arc, No):(949 771$401
<br />Irvine, CA 92614 ! AliOfiEss:
<br />INSURERS AFFORDING COVERAGE NAIC4
<br />INSURERA: Nonprofits Insurance Alliance of California 01184
<br />INSURED ; INSURERB:QBE Insurance Corporation
<br />39217
<br />2-1-1 Orange County 'INSURER C:
<br />1505 E. 17th Street
<br />Suite 100 Ia�R D:
<br />Santa Ana, CA 92705 IN URE E;
<br />_
<br />INSURERP
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SELOWHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICYPERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WF11CH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />TYPE Or INSURANCE
<br />Hap
<br />SUSR
<br />Wv0
<br />POLICYNUMBER
<br />MMIDaIYYVYI POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE [X] OCCUR
<br />Improper Sexual Cond
<br />X
<br />201903104NPO
<br />02/0112019
<br />02/01/2020
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />DAEAGET MISSeaENTED
<br />500,000
<br />X
<br />GEHL
<br />MED EXP (Anyo e arson
<br />20,000
<br />PERSONAL&ADV INJURY
<br />1,000,DOO
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑ ypior - LOC
<br />OTHER,
<br />GENERALAGGREGATE
<br />„�
<br />2,000,000
<br />PRODUCTS-COMPIOPAGO
<br />�_ 2,000,DOO
<br />SOCIALSERVICE
<br />$ 1,000,909
<br />_A
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANYAUTO
<br />OWNED BCHEOULED
<br />AUTOSONLY AUTOS
<br />HIREp X NON S%NEO
<br />AUTOS ONLY AUTOS ONLY
<br />201903104NPO
<br />02/01/2019
<br />02/01/2020
<br />COMBINED SINGLELIMIT
<br />Ca nds t
<br />1,000,000
<br />BODILY INJURY Per ema,)R
<br />_
<br />BODILY INJURY Perawltlent!$
<br />PPROPERdV DAMAGE
<br />(Perawl ant _
<br />$
<br />A
<br />X
<br />LMoREL1-A0Aa
<br />EXCESS LIAR
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />201903104UMBNPOQOOTE
<br />02/01/2010
<br />02/01/2020
<br />EACH o0CURRCNCE
<br />$ 2,000,000
<br />AGGREGATE
<br />�2,000,D00
<br />DED I RETENTION$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' uABILITY YIN
<br />�MYPPERO/MEIETOFUPPAARTNCWEXSCUTIVE I--�
<br />(M6IIG6tory 111 Nlij L.
<br />If yes, doscrlbe under
<br />DEBCRIPTION OF OPERATIONS below
<br />NIA
<br />PER : OTH-
<br />ER
<br />E.L, EACH ACCIDENT
<br />E. L. DISEASE -EA EMPLOYEE
<br />$
<br />--
<br />E.L. DISEASE - POLICY LIMIT
<br />B
<br />A
<br />Disabllky-AD&D-Trav
<br />Professional Llablll
<br />201903104ACC
<br />201903104NPO
<br />02/01/2019
<br />02/01/2019
<br />02/01/2020
<br />02101/2020
<br />)Aggregate
<br />1,000,000
<br />1,000,000
<br />DESCRIPTION OP OPERATION$ / LOCATIONS / VEHICLES (ACORD 101, Addleonal RbM014 Sohodula, mayy ba ANAchad 0more ap0w le mgWmd)
<br />Re: As Per Contract or Agreement on File with Insured. City of Santa Ana, Community Development Agency is included as an additional Insured (and Primary)
<br />on General Liability policy perthe attached endorsement, If required.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFLLED BEFORE
<br />Cityof Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Community Development Agency.
<br />Administrative Services Division M-25
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />/// / --
<br />ACORD 25 (2016103) O 1988.2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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