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NONPROFITS <br />INSURANCE <br />ALLIANCE OF CALIFORNIA <br />A Head for Insurance. A Heart for Nonprofits. <br />NONPROFITS INSURANCE ALLIANCE <br />OF CALIFORNIA (NIAC) <br />www.insurancefornonprofits.org <br />COMMERCIAL UMBRELLA POLICY DECLARATIONS <br />PRODUCER: POLICY NUMBER: 2021-24712-UMB <br />Bowermaster & Associates Insurance Agency, Inc. <br />10805 Holder St. Ste. 350 RENEWAL OF NUMBER: 2020-24712-UMB-NPO <br />Cypress, CA 90630 <br />Item 1 NAME OF INSURED AND MAILING ADDRESS: <br />Illumination Foundation; Integrated Community Healthcare Solutions; Home4Health Broadway, LLC; Illumination Housing, LLC <br />1091 N. Batavia Street <br />Orange, CA 92867 <br />Item 2 POLICY PERIOD: FROM 9/15/2021 TO 9/15/2022 <br />AT 12:01 A.M. STANDARD TIME AT YOUR, MAILING ADDRESS SHOWN ABOVE <br />BUSINESS DESCRIPTION: Provides services and temporary housing for the homeless <br />IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS <br />POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. <br />Item 3 THE ANNUAL AND MINIMUM PREMIUM DUE AT INCEPTION: <br />$51,864 <br />Item 4 LIMITS OF INSURANCE: <br />a. <br />Occurrence / Accident / Injury / Claim Limits (where applicable): ............................................ <br />7,000,000 <br />1) Each Occurrence - Commercial General Liability and Products - <br />Completed Operations Liability <br />ii) Each Accident - Business Auto Liability <br />iii) Each Injury- Liquor Liability <br />IV) Each Claim - Employee Benefits Liability <br />b. <br />Each Claim - Directors and Officers Liability.......................................................................... <br />7,000,000 <br />C. <br />Each Claim - Improper Sexual Conduct and Physical Abuse Liability ..................................... <br />2,000,000 <br />d. <br />Each Claim - Social Service Professional Liability.................................................................. <br />7,000,000 <br />Aggregate limits: <br />e. <br />Commercial General Liability, Business Auto Liability, Products- Completed Operations <br />Liability, Liquor Liability, and Employee Benefits Liability Aggregate <br />(where applicable): .................................................................................................................. <br />7,000,000, <br />f. <br />Directors and Officers Liability Aggregate.......................:........................................................ <br />7,000,000 <br />g. <br />Improper Sexual Conduct and Physical Abuse Liability Aggregate ........................................ <br />2,000,000 <br />IL <br />Social Service Professional Liability Aggregate................................................................:...... <br />7,000,000 <br />Item 5 RETROACTIVE DATES- SEE SCHEDULE OF UNDERLYING INSURANCE <br />FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY AT INCEPTION (NUMBER AND EDITION DATE): <br />CU 21 33 01 15, NIAC-EO03 UMB 08 20, NIAC-E133 UMB 05 20, NIAC-E180 UMB 0121, NIAC-E253 UMB 08 21, NIAC-E,12 UMB 09 19, SCHEDULE A 0180, UMB 231 <br />06 16, UMB 23206 16, UMB-100 06 21, UMB61 0513 <br />COUNTERSIGNED: 9/20/2021 BY <br />=40 <br />(AUTHORIZED REPRESENTATIVE) <br />THESE DECLARATIONS, THE ATTACHED SCHEDULE OF UNDERLYING INSURANCE, TOGETHER W ITH THE ATTACHED SCHEDULE OF FORMS AND ENDORSEMENTS, <br />AND ANY FORMS AND ENDORSEMENTS WE MAY LATER ATTACH TO REFLECT CHANGES, MAKE UP AND COMPLETE THE ABOVE NUMBERED POLICY. <br />Notice: This risk pooling contract is issued by a pooling arrangement authorized by California Cor <br />5006.1. The pooling arrangement is not subject to all of the insurance laws of the State of Califor <br />regulation by the Insurance Commissioner. Insurance guaranty funds are not available to pay clai <br />becomes insolvent. <br />NIAC-UMB /2-99 <br />RIa MwogementDMdon <br />�R`EVIEwED&pAPPPtIRI,OeV�@BY. <br />Risk Management Analyst <br />