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<br />AC"COR,C?°b CERTIFICATE OF LIABILITY INSURANCE DATE 03DDNYY1
<br />/2019
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<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 pollcy(ies) 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 such endorsements .
<br />PRODUCER CONTACT
<br />.:CAME _ _ _
<br />Willie Towers Watson Insurance Services west, Inc. fka Willie HONE 1-877 945 7378 N 1-B88-967-2378
<br />Insurance Services of California, Inc. p�lLg�E
<br />c/o 26 Century Blvd p OREgS�. certificates@willis oom
<br />P.O, Box 305191 INSURERS AFFORDING COVERAGE NAICq
<br />Nashville, TH 372305191 USA--`---"___La"""`J AF" "
<br />INaURFRA• Lexington insurance Company 19437
<br />INSURED
<br />The Salvation Army - Division 11
<br />30840 Hawthorne Blvd., Bldg D
<br />Rancho Palos Verdes, CA 90275
<br />OVERAGES
<br />Greenwich Insurance Company _ 22322
<br />XL Specialty Insurance Company 37885
<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 IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />(NSR-.__...._ ...�_....._._... _..,..�„:....._.:_ A $T1DR _.:"�.-.�®.-._.�_______.__ FOTI. CY. EFF. '�SCfCV�YV..
<br />�.WPEOFINSURANCEjNqD WVQF_ POUCYKUMBER IMM DO)YYYY1 IMMIDD LIMRB .�»..
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />-
<br />EACH OCCURRENCE
<br />$,, 2,000,000
<br />'D%'hTATiE'Pil`REN7E6-""
<br />_._
<br />CLAIMS -MADE ]OCCUR
<br />eff-i9J,�,asHigc0yrlatlae—
<br />$ 1,000,000
<br />A
<br />)C
<br />SIR: 4500,000 Pei Occurrence
<br />_—_
<br />MED EXPJAAn one personI __.$,
<br />0
<br />Y
<br />027712409
<br />10/01/2019
<br />10/01/2020
<br />PERSONAL2,000,000
<br />GtNjjjt
<br />AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />Y--
<br />ORGY) JECOT L^_,. LOC
<br />PRODUCTS- COMPIOP AGO
<br />4,000,000
<br />$-
<br />gT�iEIR;
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />M Ila-loAgnot- NED SINGLELMIT
<br />_
<br />g 5, 000,OW
<br />X
<br />ANYAUTO
<br />BODILY INJURY (Per Person):
<br />$
<br />H
<br />OWNED ACIIEOULED
<br />AUTOS ONLY AUTOS
<br />Y
<br />RA05000219-09
<br />10/01/2019
<br />10/01/2020
<br />BODILY INJURY(Peraccidenl)
<br />-
<br />$
<br />_
<br />___
<br />HIRED NON -OWNED
<br />PROPERfY DAMAGE
<br />_
<br />_
<br />AUTOS ONLY AUTOS ONLY
<br />[_j
<br />$
<br />UMBRELLA LIAR OCCUR
<br />EACHOCCURRENCE_.^
<br />_
<br />$
<br />EXCESS LIAB c. sans-nennc
<br />arnoc111 a
<br />e
<br />AND EMPLOYERS' LIABILITY AYIN
<br />C NYPROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? NIA Y RWD5000217-09
<br />(Mandatore In RID El
<br />L EACH ACCIDENT $ 4 +,wu,
<br />L, DISEASE -EA EMPLOYEE_ $_ 1,000,
<br />L. DISEASE POLICY LIMIT $ 1,000,
<br />C Excess Workers Compensation Y RM500021609 X110/01/2019 10/01/2020 E.L, Each Accident $1,000,000
<br />and
<br />EPerStatuteE.L, Diaeaee oiability Tel
<br />Ea OL
<br />WC - Eel $1,000,000
<br />DESCRIPTION OF OPERATIONS l LOCATIONS I VEHICLES (ACOR0101, Additional R4marks Sch.dul., may b. attochod it more spec. W unielred)
<br />Division N11-148
<br />Workers Compensation:
<br />Policy No. RWD5000217-09 provides coverage in the following states: HI,ID,MT,NM,NV,TX,DT
<br />Policy No. RWE500021609 provides coverage in the following statesi AZ,CO,OR
<br />SEE ATTACHED
<br />ByRisk MANACI6NIENTDiVISION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />0 019 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana ^------ - -
<br />Risk Management Division I AUTHORIZED REPRESENTATIVE
<br />20 Civic Canter Plaza -RA I VILl ,AREAL
<br />Banta Ana, CA 92702 IiIR Y viliL
<br />01988-2016 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />ss xo: 18625509 un'rcn: 1395017
<br />
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