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AGENCY CUSTOMER ID: ORANCNT-01 <br />LOC #: <br />AGENCY <br />Arthur J. Gallagher & Co. <br />POLICY NUMBER <br />CARRIER <br />ADDITIONAL REMARKS <br />ADDITIONAL REMARKS SCHEDULE <br />NAIC CODE <br />NAMED INSURED <br />Orange County Asian <br />& Pacific Islander Community Alliance <br />12912 Brookhurst Street, Ste. 410 <br />Garden Grove CA 92840 <br />EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />Carrier: Great American Insurance Company <br />Each Claim: $1,000,000 ,Aggregate: $3,000,000 <br />Policy: Directors & Officers Liability <br />Policy#: ND01024419T <br />Policy Term: 10/15/2021 to 10/15/2022 <br />Carrier: United States Liability Insurance Co <br />Each Claim:$1,000,000 ,Aggregate:$1,000,000 ,Retention: $2,500 <br />Policy: Professional Liability <br />Policy#: PAC 0330978 09 <br />Policy Term: 10/15/2021 to 10/15/2022 <br />Carrier: Great American Insurance Company <br />Each Claim:$1,000,000 ,Aggregate:$3,000,000 <br />Policy: CRIME <br />Policy#: 106682255 <br />Carrier: Travelers Casualty and Surety Co of America <br />Policy Term: 2/8/2022 To 2/8/2024 <br />Employee Theft: Limit: $1,750,000 / Deductible: $5,000 <br />ERISA: Limit: $1,750,000 <br />Forgery or Alteration: Limit: $1,750,000 / Deductible: $5,000 <br />Theft of money and securities: Limit: $25,000 / Deductible: $5,000 <br />Computer Fraud: Limit: $1,750,000 / Deductible: $5,000 <br />Funds transfer fraud: Limit: $1,750,000 / Deductible: $5,000 <br />Other: In Transit: Limit: $25,000 / Deductible: $5,000 <br />Page 1 of 1 <br />y of Santa Ana and The City, its officers, officials, employees, and volunteers are named additional insured under General Liability with respect to the <br />erations of the named insured. Waiver of Subrogation for General Liability applies in favor of certificate holder. The insurance provided in the General Liability <br />licy is primary and any other insurance shall be excess only, and not contributing. Written notice shall be provided at least ten (10) days in advance of <br />ncellation for non-payment of premium and thirty (30) days in advance for any other cancellation or policy change. <br />ACORD 101 (2008101) © 2008 ACORD CC <br />The ACORD name and logo are registered marks of ACORD <br />