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Francine Digdallysigned by Francine R. VillarealPage 1 of 2 r1 \ ien _ _ n.,. 9m1 In va IN. VI II AQICQI 08:30:55 -0T CERTIFICATE OF LIABILITY INSURANCE 0' DATE MMIDDflYYY) 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 Willis Towers Watson Insurance Services West, Inc. c/o 26 Century Blvd P.O. Box 305191 CONTACT Willis Towers Watson Certificate Center PNCNE Ext: 1-877-945-7378 A/C No:1-888-467-2378 E-MAIL ADDRESS: om certificates@willis.c Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAICp INSURERA: Westchester Surplus Lines Insurance Compan 10172 IThe Salvation Army - Division 17 NSURED INSURERB: Greenwich Insurance Company 22322 INSURERC: XL Specialty Insurance Company 37885 30840 Hawthorne Blvd., Bldg D Rancho Palos Verdes, CA 90275 INSURERD: INSURERE: INSURER F: IEUVttXAUt5 GtR I1HGA IF NIIMRFR: W22.1Vbb H2 Dc\rICInu ulwoco. 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 Elm TYPE OF INSURANCE ADDL UBR POLICYNUMBER POLICY EFF IMNl1DDfYYM POLICY EXP (MMIDDrYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY CLX AIMS -MADE OCCUR EACH OCCURRENCE $ 2,000, 000 DAMAGE TO NTED PREMISES Ea ocomance $ 1,000, 000 X X MEO EXP (Any one person) $ 0 A Self Insured Retention: y G7183119A 002 10/01/2021 10/01/2022 $_1 000,000 PERSONAL &AOV INJURY $ 2,000,000 AGGREGATE UMITAPPLIES PER: POLICY D O- JEPRCT 1XI LOC GENERALAGGREGATE $ 4,000,000 GEN'L PRODUCTS - COMP/OP AGO $ 4,000, 000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEOULEO AUTOS ONLY AUTOS BODILY INJURY IPeracddent) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LAB H OCCUR EACH OCCURRENCE $ AGGREGATE g EXCESS UAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION ANDEMPLOYERS'LIABIUTY YIN ANYPROPRIETORNARTNERIEXECULVE ❑ OFFICERIMEMSER EXCLUDED? NIA PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E. L. DISEASE -EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT S DESCRIPTION OF OPERATIONS below B Excess Auto Liability - CA Y RAE500021811 10/01/2021 10/01/2022 Any Auto / CSL $3,000,000 Self-Insd Retention $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana Risk Management Division AUTHORIZED REPRESENTATIVE 20 Civic Center Plaxa�r - Y Santa Ana, CA 92702 � REVIEWET'J6 MPktT/®6Y: ©1988-2016 ACORD C 11M,c ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ' x Rhk Management Analyst SR ID: 21630631 HATcH: 2252947