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<br />i`-� ✓4.J•'/i L.� CERTIFICATE OF LIABILITY INSURANCEllk
<br />DATE IMM/ODIYYYY)
<br />10/02/2020
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).
<br />PRODUCER
<br />Willis Towers Watson Insurance Services West, Inc.
<br />c/o 26 Century Blvd
<br />P.O. Box 305191
<br />CONTACT Willis Towers Watson Certificate Center
<br />NAME:
<br />PHONE 1-877-945-7378 FAX 1-BSS-467-2378
<br />AIC No:
<br />E pRIE certificates@.illis.com
<br />INSURERS AFFORDING COVERAGE
<br />HAIG#
<br />Nashville, TN 372305191 USA
<br />INSURERA: Westchester Surplus Lines Insurance Compan
<br />10172
<br />INSURED
<br />The Salvation Army - Division 11
<br />30840 Hawthorne Blvd., Bldg D
<br />INSURER B: Greenwich Insurance Company
<br />22322
<br />INSURER C: XL Specialty Insurance Company
<br />37885
<br />INSURER D:
<br />Rancho Palos Verdes, CA 90275
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: W18183077 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADOL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY BEE
<br />MMIDDVYYYY
<br />LIMITS
<br />X
<br />COMMERCIALGENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE -I—XI OCCUR
<br />DAPREMAAGE TO RENTED owunence
<br />ISES Ee
<br />$ 1,000,000
<br />X
<br />MED EXP(My one person)
<br />$ 0
<br />A
<br />Self Insured Retention:
<br />X
<br />$1,000,000
<br />y
<br />G7183119A001
<br />10/01/2020
<br />10/01/2021
<br />PERSONAL&ADV INJURY
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$ 4,000,000
<br />POLICY jE C X LOG
<br />PRODUCTS - COMP/OPAGO
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(Ed accident
<br />$ 5,000,000
<br />X
<br />BODILY INJURY (Per parson)
<br />$
<br />ANY AUTO
<br />B
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />y
<br />RAD500021910
<br />10/01/2020
<br />10/01/2021
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTYDAMAGE
<br />Per accldenl
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />H
<br />UMBRELLALIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />H
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I I RETENTION
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETOPIPARTNERIEXECUTIVE YIN
<br />OFFIGER/MEMBEREXCLUDEDT No
<br />(Mandatory In NH)
<br />N/A
<br />y
<br />RWD500021710
<br />10/01/2020
<br />10/01/2021
<br />x TERSTATUTE ERH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E, L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />B
<br />Excess Auto Liability - CA
<br />RAE500021810
<br />10/01/2020
<br />10/Ol/2021
<br />Any Auto / GEL
<br />$3,000,000
<br />I
<br />ITI
<br />8e1£-Intl Retention
<br />$2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required)
<br />Division $11-148
<br />Workers Compensation:
<br />Policy No. RWDS00021710 provides coverage in the following states: HI, ID, MT ,NM, NV, UT
<br />Policy No. RWR300094405 provides coverage in the following states: AK
<br />SEE ATTACHED
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana,_ CA 92702
<br />ACORD 25 (2016103)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />©1988.2016
<br />The ACORD name and logo are registered marks of ACORD
<br />SR ID: 20160526 ewxce: 1836068
<br />„� RIAMmaglmemtDlWalpn
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<br />REVIEWED& APPROVED BY:1
<br />Rnk lykinagelnent Analyst
<br />
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