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IED I <br />NONPROFITS <br />INSURANCE <br />ALLIANCE OF CALIFORNIA <br />A Head for Insurance. 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: 2021-01143-UMB <br />Heffernan Insurance Brokers <br />18004 Sky Park Circle, Suite 210 RENEWAL OF NUMBER: 2020-01143-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 9/23/2021 TO 9/23/2022 <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: $4,337 <br />Item 4 LIMITS OF INSURANCE: <br />a. Occurrence / Accident / Injury / Claim Limits (where applicable): ............................................ 5,000,000 <br />i) Each Occurrence - Commercial General Liability and Products - <br />Completed Operations Liability <br />ii) Each Accident - Business Auto Liability <br />iii) Each Injury - Liquor Liability <br />iv) Each Claim - Employee Benefits Liability <br />b. Each Claim - Directors and Officers Liability.......................................................................... Excluded <br />C. Each Claim - Improper Sexual Conduct and Physical Abuse Liability ..................................... 5,000,000 <br />d. Each Claim - Social Service Professional Liability.................................................................. 5,000,000 <br />Aggregate limits: <br />e. Commercial General Liability, Business Auto Liability, Products- Completed Operations <br />Liability, Liquor Liability, and Employee Benefits Liability Aggregate <br />(where applicable): .................................................................................................................. 5,000,000 <br />f. Directors and Officers Liability Aggregate................................................................................ Excluded <br />g. Improper Sexual Conduct and Physical Abuse Liability Aggregate ........................................ 5,000,000 <br />h. Social Service Professional Liability Aggregate....................................................................... 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-E180 UMB 01 21, NIAC-E253 UMB 08 21, NIAC-E42 UMB 09 19, SCHEDULE A 01 80, UMB 231 <br />06 16, UMB 232 06 16, UMB-100 05 21, UMB166 12 88, UMB62 05 13 <br />COUNTERSIGNED: 9/29/2021 BY <br />(AUTHORIZED REPRESENTATIVE) <br />THESE DECLARATIONS, THE ATTACHED SCHEDULE OF UNDERLYING INSURANCE, TOGETHER WITH THE ATTACHED SCHEDU' <br />AND ANY FORMS AND ENDORSEMENTS WE MAY LATER ATTACH TO REFLECT CHANGES, MAKE UP AND COMPLETE THE ABO� <br />la MmrganoitDivhian <br />Notice: This risk pooling contract is issued by a pooling arrangement authorized by California Corl <br />I , n�A.. <br />5005.1. The pooling arrangement is not subject to all of the insurance laws of the State of Califorr <br />regulation by the Insurance Commissioner. Insurance guaranty funds are not available to pay clad <br />Rsk Management Clefi-1 Aide <br />becomes insolvent. <br />NIAC - UMB / 2-99 <br />