Laserfiche WebLink
CERTIFICATE OF WORKERS' COMPENSATION COVERAGE lna7 E <br />2021 <br />PRODUCER <br />NonPmfits' United Workers' Compensation Group <br />610 Fulton Avenue, Sulte2W <br />Sacmmonto, CA 95825 <br />THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY <br />AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />Phone: (916) 868.6231 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />Fax: (916) 880.5251 COVERAGE AFFORDED BY THE POLICIES BELOW. <br />ArthurJ. Gallagher & Co Insurance Brokers of California, Inc <br />1255 Battery 4 <br />SauFraociscD,12A <br />OA 94111 <br />INSURERS AFFORDING COVERAGE <br />INSURED <br />- <br />INSURERA; NonProfits' United Workers' Compensation Group <br />Habitat for Humanity Of Orange County <br />Ritchey Street <br />INSURER B: SafB National Casualty Corp2200 <br />f! INAIIGYf15105] <br />Santo Ana, CA 92705 <br />INSURER D: Response Indemnity Company of California [NAJC II tO970] <br />INSURER D: - <br />- <br />INSURER E <br />COVERAGES This Cerilloate is not intended to s Gul all endorsoments, covers es, terms, conditions and excluslona ofYhe olicies shown, <br />THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSOEOTOTHE AFFILIATE MEMBER NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWIT18TANDINGANY <br />REQUIREMENT, TERM, OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE <br />COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS <br />SHOWN. MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INBR <br />LTR <br />TYPE OF COVeRAGE <br />POLICY NUMBER <br />PODCY <br />EFFECTIVE PATE <br />POLICY <br />EXPIRATION <br />LIMBS <br />GENERAL LIABILITY <br />EACHOCCURRENCE <br />COMMERCIAL GENERAL LN81LrrY <br />FIRE DAMAGE (Any one lire) <br />CLAIMS MADE I JOCCUR <br />MEP EXPENSE (Any one <br />`- <br />GENERAL AGGREGATE LIMIT APPLIES PER: <br />PERSONAL &ACV INJURY <br />$ <br />POLICY PROJECT LOC <br />._e......__..... <br />GENERAL AGGREGATE <br />$ <br />PRODUCTS-COMPAJPAGG <br />$ <br />._ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMB <br />(Each eeetdw) <br />$� <br />.. <br />ALLOWNEDAUTOS <br />BODILY <br />NJ BODILY INJURY <br />er NJ <br />$ <br />SCHEDULEDAUTOS <br />HIRED AUTOS <br />BODILY INJURY <br />(Per axldw) <br />� <br />$ <br />NON-OWNEDAUTOS <br />N <br />PROPERTY DAMAGE <br />erealdent <br />A <br />WORKERS' COMPENSATION <br />AND <br />EMPLOYERS LIABILITY <br />NPU-WCG001-2021 <br />1/l/2021 <br />I/l/2022 <br />W PER <br />AA STATUTE <br />0 <br />T <br />E,L EACH ACCIDENT <br />$ 500,000 <br />EL. DISEASE-EA.EMPLOYEE <br />$ 500,000 <br />ISEASE-COVERAGE <br />LIMIT <br />$500,900 <br />DTHRM <br />C <br />B <br />XSWC-Bufer Layer <br />XSWC <br />ABLIOOOO13-00 <br />SP4064079 <br />1/1/2021 <br />1/1/2021 <br />1/1/2022 <br />1/1/2022 <br />XS of $500,D0o <br />xSof$750,000 <br />XS of $750,000 <br />$250,000 (EL & WC) <br />$2,000,000(EL) <br />Statutory (WC) <br />DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAUPROVISIONS <br />Waiver of Subrogation provided by Endomcment No. NPL)WCG-7HHOC-05R <br />CERTIFICATE HOLDER <br />CANCELLATION <br />NPUWCO-I4HOC-OSR <br />City of Santa Ana <br />Risk Management Division <br />SHOULD ANY OF THE ABOVE DESCRIBE[) POLICIES BE CANCELLED <br />BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED <br />IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />APPR <br />Santa Ana, CA 92702 <br />VEt <br />t3 ANA - T <br />VISIOf <br />Based on ACORD 25 (2016/03) <br />' <br />tr�� 2021 <br />�2 <br />IwIPsI!!; <br />