LUTHERAN SOCIAL SERVICES OF SOUTHERN CALIFORNIA

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ACOR& CERTIFICATE OF LIABILITY INSURANCE 11 rDATE(MMODNYYY) 1 04/14/2021 THIS CERTIFICATE IS ISSUED ASA 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($), 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 endomement(s). PRODUCER CONTACT Elsy Fuentes NAME: Commercial Management Insurance Services Inc. RHONE (714) 414-1167 F X (714)414-1195 AMAIL Ext : AIC, No CA License OD85858 ADOREss: elsy@cmis-ins.com 751 S Weir Canyon Rd, 157-355 INSURER(S) AFFORDING COVERAGE NAIC q Anaheim CA 92808 INSURER A: Redwood Fire & Casualty 11673 INSURED INSURER B Lutheran Social Services Of Southern California INSURER C: DBA LSS Community Care INSURER D: 247 E. Amerige Ave. INSURER E : Fullerton CA 92832 INSURER F: CERTIFICATE NUMRFR- 2021 THIS IS TO CERTIFY THATTHE 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSR WVD - POLICY NUMBER POLICY EFF MMIDDn(YYY) POLICY EXP (MMIDDNYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -OE OCCUR EACH OCCURRENCE $ E PREMISES Ea occurrence $ MED EXP(Any one emon) $ PERSONAL &AOV INJURY $ GEN-L AGGREGATE LI MIT APPLIES PER: POLICY PRO.JECT LOC GENERALAGGREGATE $ PRODUCTS - COMPIOPAGG $ $ OTHER, AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acclent $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE IPeraxitlent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MODE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEREXECUTIIVE ❑ OFFICERIMEMBER EXCLUDED? NIA LUWC217692 01/01/2021 01/01/2022 v PER OTH. STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes, DESCRIPTION DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) EVIDENCE OF INSURANCE COVERAGE CITY OF SANTAANA RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLAZA SANTAANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVEy RNk MangvwdlXWlon I&VI M&APPROVrDBc CA 92701 01gRR-2015ACOR❑ RakManaaemmoClniralAitle ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD V'