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BENE&PR-01
<br />CERTIFICATE OF LIABILITY INSURANCE I DATE,(MM/UD^Y Y)
<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(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 endorsements .
<br />PRODUCER Licensee#UM10410 CONTACT
<br />INSURED
<br />Business and Insurance Solutions PHONE ---------- - Ptiz -..— — -""-
<br />(A/C, No, Ext): (949) 381-7700 (A/C, Ne):(949) 861-9429
<br />Benevolent & Protective Order of Elks #794
<br />1751 S. Lyon St
<br />Santa Ana, CA 92705
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR ADD SUBR MIDDNEYF PMIDYEXP
<br />OLI
<br />TYPE OF INSURANCE
<br />LTR p p POLICY NUMBER
<br />A
<br />X
<br />I COMMERCIAL GENERAL LIABILITY
<br />_LIMITS
<br />1,000,000
<br />7 CLAIMS -MADE LX.I OCCUR
<br />X
<br />PAC395275100
<br />5/29/2021
<br />6/2912022
<br />EAG1OCCURRENCE__ _
<br />pR AGE.SO a ocTEDeccej_
<br />.$ _
<br />1,000,000
<br />_
<br />. $
<br />MEDEXPLAnVone persoaL_.
<br />$, 10,000
<br />......"."._-
<br />PERSONAL &AOV INJURY
<br />1,000,000
<br />GENE
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE —.
<br />2,600,006
<br />".$—
<br />__ _ -_
<br />PRODUCTS-COMP/OPAGG.-.$__
<br />2,000,000
<br />POLICY zee - LOC
<br />OTHER:
<br />--
<br />A
<br />AUTOMOBILE
<br />-.
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />1,000,000
<br />$........
<br />ANYAUTO
<br />PAC395275100
<br />5/29/2021
<br />5/29/2022
<br />BODILY INJURY (Per person)_
<br />$
<br />-Xqq
<br />-..
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />AU1"OS ONLY X NON -OWNED ONLY
<br />—
<br />BODILY IN_JURY-(Per.WdenU
<br />Rq pp
<br />PeOPEkd nt)AMAGE
<br />--'----------
<br />$
<br />$
<br />EACH OCCURRENCE-.,.—_
<br />$ 1,000,000
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X. OCCUR
<br />—
<br />EXCESS LIAB CLAIMS -MADE
<br />."
<br />—""_- --
<br />UMB395275200
<br />5/2912021
<br />5/29/2022
<br />AGGREGATE
<br />1,000,000
<br />DED X RETENTION! 10,000
<br />—
<br />.........
<br />_.-
<br />B
<br />AND EMPLOYERS COMPENSATION
<br />X---�^TATIfI� 1LRH
<br />YIN_.._
<br />ANY PROPRIEIORIPARTNER/EXECUTIVE
<br />NIA
<br />WSD506302200
<br />1215/2021
<br />12/5/2022
<br />E.L EACH ACCIDENT
<br />_ "_.
<br />$ 1,000,066
<br />qqEF ICERIMEMBER EXCLUDED?
<br />an, to ry
<br />_-.._
<br />..
<br />1,000,000
<br />eNH)
<br />If descro
<br />as, describe under
<br />. E.L. DISEASE_. EA, EM PLOYE-.
<br />'
<br />$
<br />DESCRIPTION OFOPERATIONSbelow
<br />E, L. DISEASE -POLICY LIMIT
<br />$ 1,000,660
<br />A
<br />Abuse &Molestation
<br />PAC395275100
<br />5/29/2021
<br />5/29/2022
<br />Each Abuse Limit
<br />1,000,000
<br />A
<br />Abuse & Molestation
<br />PAC395275100
<br />5/29/2021
<br />5/29/'2022
<br />Aggregate Limit
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD LIU, Additional Remarks Schedule, maybe attached If more space Is requlrad)
<br />City of Santa Ana is included as Additional Insured as respects General Liability per the attached forms.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />s �?�` RWr.MG1a�eJ11¢rItDL'I4i0K
<br />J �f(R1M �7. yjy,� g lI REviEWED&APmv®BV:
<br />ACORD 25 2016103 c 8%
<br />( ) O 1988-2015 ACORD C �.
<br />The ACORD name and logo are registered marks of ACORD �®--"' Risk Managemem supervisor
<br />
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