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Francine ,'. Digitally signed by '. Francine R. VillarealPag s 1 of 2 _i nnto 9n9i in?R r4N R. R[� VIIIcIICc1108:30:55-07'0' CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIVYYy) 09/29/2021 THIS CERTIFICATE IS ISSUED AS A 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(S), 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 endorsement(s). PRODUCER Willie Towers Watson Insurance Services West, Inc. c/o 26 Century Blvd P.O. Box 305191 CONTACT Willis Towers Watson Certificate Center NAME: PHONE 1-877-945-737B FAX 1-888-467-2378 EMAIL ADDRESS: -certificates@willis. corn INSURERSAFFORDINGCOVERAGE NAIC# Nashville, TN 372305191 USA INSURER A: Westchester Surplus Lines Insurance Compan 10172 INSURED The Salvation Army,- Division 17 30840 Hawthorne Blvd., Bldg D INSURER B: Greenwich Insurance Company 22322 INSURER C: XL Specialty Insurance Company 37885 INSURER D: Rancho Palos Verde., CA 90275 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W22306682 REVISION NUMBER: THIS IS TO CERTIFY THAT THE 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE .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 OF INSURANCE AODTYPE INSD MID POLICY NUMBER MM/POLDDIYYYY EFF MMIDDY FXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE I OCCUR DAMAGEExcED PREMISESS a occurrence $ 1,000,000 X MED EXP(Any one person) $ 0 A Self Insured Retention: X $1,000,000 y G7163119A 002 10/01/2021 10/01/2022 PERSONAL &ADV INJURY $ 2,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 GERL POLICY PRO- ECT LOC PRODUCTS-COMPIOP AGG $ 4,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea eccldent $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE Per eccldent $ $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER E.L. EACH ACCIDENT $ OFFICERIMEMB REXCLUDED?ANYPROPRIETOWPARTNEWEXECUTIVE ❑ NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, docents under DESCRIPTION OF OPERATIONS be. E.L. DISEASE -POLICY LIMIT $ B Excess Auto Liability - CA y RAE500021811 10/01/2021 10/01/2022 Any Auto / CSL $3,000,000 Self-Insd Retention $2,OOD,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Location Code: 17-145-10-01-01 - Santa Ana Hospitality House Shelter CA -Business Auto is fully Self -Insured per the attached State Certificate. SEE ATTACHED City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana. CA 92702 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 REPRESENTATIVE A�� ©1988-2016 ACORD Ci ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD sa m: 21630631 uI 2252947 9 e RlekManagmnentDkislon ss RREmEWED&pAPPROVED BY:: Risk Management Analyst