Laserfiche WebLink
NONPROFITS <br />INSURANCE <br />ALLIANCE OF CALIFOPN[A <br />A Head for ►nsuronee. A Heart for Nonprofits. <br />NONPROFITS INSURANCE ALLIANCE <br />OF CALIFORNIA (NIAC) <br />www.insurancefornonprofits.org <br />COMMERCIAL UMBRELLA POLICY DECLARATIONS <br />PRODUCER: POLICY NUMBER: 2020-01143-UMB <br />Heffernan Insurance Brokers <br />18004 Sky Park Circle, Suite 210 RENEWAL OF NUMBER: 2019-01143-UMB-NPO <br />Irvine, CA 92614 <br />Item 1 NAME OF INSURED AND MAILING ADDRESS: <br />Human Options, Inc. <br />P.O. Box 53745 <br />Irvine, CA 92619 <br />Item 2 POLICY PERIOD: FROM 9/23/2020 TO 9/23/2021 <br />AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE <br />BUSINESS DESCRIPTION: Residential care facility and counseling offices <br />IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS <br />POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. <br />Item 3 THE ANNUAL AND MINIMUM PREMIUM DUE AT INCEPTION: $4,250 <br />Item 4 LIMITS OF INSURANCE: <br />a. Each Occurrence (other than Directors' & Officers' Liability, Improper Sexual Conduct and <br />Physical Abuse Liability, and Social Service Professional Liability) ........................................ <br />5,000,000 <br />Each Wrongful Act - Directors' & Officers' Liability................................................................. <br />Excluded <br />Each Occurrence - Improper Sexual Conduct Liability........................................................ <br />5,000,000 <br />Each Occurrence - Social Service Professional Liability......................................................... <br />5,000,000 <br />b. Products Completed Operations Aggregate [(where applicable)] ....................................... <br />5,000,000 <br />C. General Aggregate.............................................................................................................. <br />5,000,000 <br />d. Directors' & Officers' Liability Aggregate.............................................................................. <br />Excluded <br />e. Improper Sexual Conduct Liability Aggregate....................................................................... <br />5,000,000 <br />f. Social Services Professional Liability Aggregate................................................................... <br />5,000,000 <br />Item 5 RETROACTIVE DATES - SEE SCHEDULE OF UNDERLYING INSURANCE <br />FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY AT INCEPTION (NUMBER AND EDITION DATE): <br />CU 21 33 01 15, NIAC-EO03 UMB 08 20, NIAC-E133 UMB 05 20, NIAC-E42 UMB 09 19, SCHEDULE A 01 80, UMB 231 06 16, UMB 232 06 16, UMB-100 08 18, <br />UMB166 12 88, UMB62 05 13 <br />COUNTERSIGNED: 9/21/2020 BY <br />&Jo�� e 4, <br />(AUTHORIZED REPRESENTATIVE) <br />THESE DECLARATIONS, THE ATTACHED SCHEDULE OF UNDERLYING INSURANCE, TOGETHER WITH THE ATTACHED SCHEDULE OF FORMS AND ENDORSEMENTS, <br />AND ANY FORMS AND ENDORSEMENTS WE MAY LATER ATTACH TO REFLECT CHANGES, MAKE UP AND COMPLETE THE ABOVE NUMBERED POLICY. <br />Notice: This risk pooling contract is issued by a pooling arrangement authorized by California Cor <br />5005.1. The pooling arrangement is not subject to all of the insurance laws of the State of Califor ��DMsiun <br />oRaNe <br />regulation by the Insurance Commissioner. Insurance guaranty funds are not available to pay clai ' z REVIEWED&APPROVED BY. - <br />becomes insolvent. (!� <br />�i <br />Risk Management Analyst <br />NIAC - UMB / 2-99 <br />