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Francine Digitillysigned by
<br />Francine R. Villareal
<br />R. Villareal °S;Qo520'000'
<br />AcoRU® CERTIFICATE OF LIABILITY INSURANCE
<br />`/
<br />DAM MMADDAYYY)g
<br />1 07/30/2020
<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(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
<br />CONTACT _Nora Wolkoff
<br />NAME: _
<br />Dickerson Insurance Services an Alera Group Company
<br />PHONE 323-805-2918 SMI FAX No
<br />1918 Riverside Drive, Los Angeles, CA 90039
<br />noose : Nom@dickemon-group.com
<br />INSURER(SI AFFORDING COVERAGE
<br />NAIC It
<br />License#OM29112
<br />INSURER A: Philadelphia Indemnity Insurance Company
<br />18058
<br />INSURED
<br />INSURER B: Service American Indemnity Company
<br />39152
<br />INSURERC:
<br />Charitable Ventures of Orange County
<br />INSURERD:
<br />4041 MacArthur Blvd Ste 510
<br />INSURERE:
<br />Newport Beach, CA 92660-2503
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 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 NTH 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />AODL
<br />SUBR
<br />POLICY NUMBER
<br />MMN�E�
<br />MMNO�
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />CLAIMS -MADE ® OCCUR
<br />PREMISES Ea occ mence
<br />$ 100,000
<br />MED EXP (My oneperson)
<br />$ 5,000
<br />Sexual / Physical Abuse
<br />PERSONAL S ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />PHPK2137435
<br />07/15/2020
<br />07/15/2021
<br />GENL AGGREGATE LIMIT APPLIES PER:
<br />POLICY 1:1 JE° LOC
<br />GENERALAGGREGATE
<br />S 2,000.000
<br />PRODUCTS -COMP,OP AGO
<br />$ 2,000,000
<br />S / PA AGGREGATE
<br />s 300,000
<br />OTHER.
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident)
<br />$ 1,000,000
<br />BODILY INJURY (Per pereon)
<br />$
<br />ANY AUTO
<br />A
<br />OWNED SCMEOULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON-0WNED
<br />AUTOS ONLY AUTOS ONLY
<br />y
<br />PHPK2137435
<br />07/15/2020
<br />07/15/2021
<br />BODILY INJURY (Per aaidem)
<br />$
<br />PROPERTY DAMAGE
<br />PeracrlderX
<br />$
<br />S
<br />UMBRELLA WB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />$ 4,000,000
<br />A
<br />EXCESS LIAB
<br />ClZMADE
<br />Y
<br />PHUB723821
<br />07/15/2020
<br />07/15/2021
<br />LIED
<br />Xl RETENTIONS 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />S' AND EMPLOYERLIABILITY YIN
<br />ANY OFFICER/A1IET R'A"n" EXCLUDED? FY
<br />(Mandatory, In NH)
<br />NIA
<br />SATIS0326700
<br />07/15/2020
<br />07/15/2021
<br />PER OTI+
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, desaibs under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />S 1,000,000
<br />Property! Equipment CoverageA
<br />PHPK2137435
<br />0711512020
<br />07115/2021
<br />Limit of Insurance
<br />$127,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional numerics Schedule, may be attached if more space is required)
<br />CITY —Its officers, employees, agents, volunteers, and representatIves are Included as Additional Insureds with respect to the operations Of the named insured
<br />subject to policy terms and conditions.
<br />City of Santa Ana
<br />Risk Management Division, 4th Floor
<br />20 CNic Center Plaza
<br />Santa Ana, CA 92702
<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 />AUTHORIZED REPRESENTATIVE
<br />NORA WOLKOFF
<br />(S) IQRR-2n15 ACnRn CnR
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />_ A-201
<br />FRV
<br />RklManagementDiabion
<br />[REVIEWED &{�APPROVED BY.'
<br />oA.11El _II.IP_t' r �hHlM�e ram. Vae��x.
<br />®'
<br />® Risk Management Analyst
<br />
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