ORANGE COUNTY CONSERVATION CORPS (6)

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A� & CERTIFICATE OF LIABILITY INSURANCE DAT12/8/2020 YI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Arthur J. Gallagher & Co. Insurance Brokers of California, Inc. LIC# 0726293 1255 Battery Street #450 San Francisco CA 94111 CONTACT NAME: PHONE FAX TAIC No Extl: LAIC No EMfiADDRESS, INSURERS AFFORDING COVERAGE NAIC# INSURERA: NonProfits' United Workers' Compensation Group INSURED NONPUNI-01 Orange County Conservation Corps 1853 North Raymond Avenue INSURERS: Safety National Casualty Corporation 15105 wsuRERc; Response Indemnity Company of California 10970 INSURER D : Anaheim, CA 92801 -INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 1153230747 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE AODL INSO SUER MO POLICYNUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DDII^/YY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 11 OCCUR EACH OCCURRENCE $ TJT9A RENTED PREMISES Ee occurrence $ GENL MED EXP (An one person) $ PERSONAL &ADV INJURY $ AGGREGATE LIMIT APPLIES PER POLICY ❑ ECT PRO- ❑LOG OTHER: GENERAL AGGREGATE $ PRODUCTS-COMP/OPAGG $ $ AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINEDSINGLE LIMIT 1Ea accldanll $ _ BODILY INJURY (Per person) $ BODILY ( ) INJURY Per accident $ PROPERTY DAMAGE Per accident) $ UMBRELLALIAE EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE_ _ $ DED RETENTION$ $ A WORKERS COMPENSATION ANDEMPLOYERS'LIABILITV YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED9 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA NPU-WCG 001-2021 1/1/2021 1/1/2022 X PER OTH- ER _STATUTE E.L. EACH ACCIDENT $500,000 E.L. DISEASE -EA EMPLOYEE $ 500,000 E.L. DISEASE -POLICY LIMIT $500.000 O B XSWC - Buffer Layer XSWC ABL1000013-00 SP4064079 1/1/2021 11112021 1/1/2022 1/1/2022 XS of$500,000 XS of$750,000 XS of $760,000 $25Q000(EL&WC) $2,000,OOO (EL) Statutory (WC) DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Santa Ana 20 Civic Center Plaza 4th Floor Santa Ana CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD .B M RlekManagemalEDMslon eri, `g �°: REVIEVIED&APPROVE) By: 8lialrnr III ;?rt srt at P, (f` Risk Management Analyst