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<br />A�ORD CERTIFICATE OF LIABILITY INSURA P"Da edNh6XTE MMAR121
<br />�4�vedo:D� � 02(Ifj12�/21�21
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON T#4_ CER1ikdTkA_3H69kEk 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 License # DC68567
<br />N%NI,cT Certificate Department
<br />BOB Insurance Services
<br />2001 E. Financial Way, Suite 200
<br />Glendora, CA 91741
<br />PHONE FAX
<br />(AIc, No, Ext: (626) 610-9500 IAIc, Ne):(626) 610-9299
<br />AMkSS, certificates@cdsinsurance.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC II
<br />INSURER A:Travelers Ind CO Of CT
<br />25682
<br />INSURED
<br />INSURER B:Travelers Prop Cas Co of America
<br />25674
<br />Shelter Providers of Orange County DBA: HomeAid Orange
<br />County
<br />INSURER C: State Compensation Ins. Fund
<br />35076
<br />17821 17th Street, Suite 120
<br />INSURER D
<br />INSURER E :
<br />Tustin, CA 92780
<br />INSURER F :
<br />COVF_RAr,FS CFRTIFIr.ATF NIIMRFP- DRVIQInM ku lannc D.
<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 />NSR
<br />LTRA
<br />TYPE OF INSURANCE
<br />ADDINSOL
<br />SUBp
<br />POLICY -NUMBER
<br />POLICVEFF
<br />POLICY EXP
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑X .00CUR
<br />P-660-506D7877-TOT-21
<br />121112021
<br />121112022
<br />EACH OCCURRENCE
<br />$ 1,000,006
<br />DAMAGE TO RENTED
<br />EBEMISES Eaccc uI
<br />300000
<br />MED EXP LMY onesemen)
<br />5,000
<br />PERSONAL &ADV INJURY
<br />Excluded
<br />GENL
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY JEOT Y LOC
<br />GENERAL AGGREGATE
<br />2,000,000
<br />PRODUCTS - COMP/OP AGO
<br />2,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident)
<br />1,000,000
<br />BODILY INJURY Per arson
<br />$
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOSWwr
<br />BA-1L302926-21.43-G
<br />121112021
<br />121112022
<br />BODILY INJURY Per accldenl
<br />X
<br />AUTOS ONLY X Al0fINa%NFD
<br />reIaccloent IMAGE
<br />$
<br />B
<br />UMBRELLA LIAB
<br />I
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />EX-8J573284-21.43
<br />12JI12021
<br />12/112022
<br />DED X RETENTION$ 0
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />pApNppY PERIME TORIPARTNERIEXECUTIVE
<br />tklandatory In EXCLUDED? EXCLUDED4.
<br />NH)
<br />under
<br />DESCRIPTIf yes, ION OFF
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />914710421
<br />111112021
<br />111712022
<br />)( PER OTH-
<br />S E
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEABE-EA EMPLOYE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS/LOCATIONS / VEHICLES ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required)
<br />City of Santa Ana, Its officers, employees, agen�a, volunteers & representatives are named as Additional Insured on the General Liability with respects to the
<br />operations of the named insured per the attached endorsement form CIS 0411 04 08. Insurance Is primary and non-contributory per attached policy form CIS
<br />T1 00 0219.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92701
<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 />ACORD 25 (2016103)
<br />©1988-2015 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />tick ManagS:mcntSprxratfat
<br />
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