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Tori Pierson w°'e'e'nz;9oas10:027emnn. <br />a— 1 AIU,StK-U1 <br />JOHNSON <br />pA7/19/OD/YYYYJ <br />7119/2021 <br />AI CERTIFICATE OF LIABILITY INSURANCE <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(les) 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 endorsements). <br />PRODUCER License # 0827761 <br />& <br />EACT Sandra Johnson <br />CalNonprofits Insurance Services <br />PO Box 640 <br />Capitols, CA 95010 <br />PHONE FAX <br />Alc, No, Ext): (213) 401A 014 (AIC, No): <br />Xi%AIE . sandra@cal-insurance.org <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURER A: Nonprofits Insurance Alliance of California <br />10023 <br />INSURED <br />AIDS Services Foundation of Orange County dba Radiant <br />Health Centers <br />INSURERS: Service American Indemnity Company <br />39152 <br />INSURER C <br />INSURER D <br />17982 Sky Park Circle, Ste. J <br />INSURER E: <br />Irvine, CA 92614 <br />INSURER F: <br />COVERAGES CF_RTIFICATF NIIMRFR• Rclncrnkl KII IkaRRR. <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 />ILSR <br />TYPE OF INSURANCE <br />ADUL <br />p <br />SUER <br />WIVID <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXP <br />pp <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADEOCCUR <br />X <br />X <br />2021-08363 <br />7129/2021 <br />712912022 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />URMAISEULTU RENPEMS (Ea cure nce <br />$ 500,000 <br />MED EXP (Any one erson <br />20,000 <br />PERSONAL &ADV INJURY <br />11000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY 1:1wf LOC <br />GENERAL AGGREGATE <br />3,000,000 <br />GEN'L <br />X <br />PRODUCTS - COMPIOP AGG <br />3,000,000 <br />OTHER: <br />A <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />S�Wr p <br />AUTOS ONLY AilT05 ONY <br />2021-08363 <br />7/2912021 <br />712912022 <br />CEOMaBINED SINGLE LIMIT <br />$ 1000000 <br />BODILY INJURY Perperson) <br />$ <br />BODILY INJURY Per accident <br />$ <br />PeOaccitlent AMAGE <br />$ <br />A <br />X <br />UMBRELLA LIAB <br />EXCESS LIAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />2021.08363-UMe <br />712912021 <br />712912022 <br />EACH OCCURRENCE <br />2,000,000 <br />AGGREGATE <br />2,000,000 <br />DIEDX RETENTION$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />QAQN��Y PRO�PRIETORI EXCLUDRIEXECUTIVE <br />(manCatolry in NH)EXCLUDED? <br />DIf <br />ESCRIPTION OF OPERATIONS below <br />NIA <br />SATIS0394900 <br />11112021 <br />1!1/2022 <br />X PER H. <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE - EA EMPLOYE <br />$ 1,000,000 <br />E.L. DISEASE -POLICY LIMIT <br />1,000,000 <br />A <br />PROF Liability <br />2021-08363 <br />7/2912021 <br />712912022 <br />$lM/Event-Aggregate <br />3,000,000 <br />A <br />Abuse & Molestation <br />2021.08363 <br />712912021 <br />7/2912022 <br />Ea. Claim/Aggregate <br />1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule. may be attached If more space Is required) <br />City of Santa Ana, officers, agents, employees, and volunteers are named as Additional Insured with respect to General Liability as required by written <br />contract per forms attached.Coverage Is Primary & Non-contributory and Blanket Waiver of Subrogation applies. <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <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 PROVE"""" <br />AUTHORIZED REPRESENTATIVE $'4j RE'lkFkD&APPRroyso8; <br />76v Pivnwu <br />Risk Marwaemmt❑encilAide <br />ACUKU Zb tZU10/U3f @ 1988.2015 ACORD C(V - 'J <br />The ACORD name and logo are registered marks of ACORD <br />