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Francine R. €, Digitally signed by Francine R. <br />1� Vlllareal <br />Villareal ( TOate:2021.08.1010:47:45 <br />-0T00' <br />/;� CERTIFICATE OF LIABILITY INSURANCE <br />DATEIMMNDNYYY) <br />7/28/2021 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONPERS 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 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 poltay(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder In lieu of such endamement(s). <br />PRODUCER <br />Conray Ins Brokers & Risk Managers <br />2522 N. Santiago Blvd. <br />LicY0543173 <br />Orange CA 92867 <br />NA E: OT Christine Campbell <br />(877)450-1872 jnlo. Nol: n1A10ae-a 186 <br />EONE <br />pOREss: a hzistineo@mnroyins.com <br />INSURERla1 AFFORDING COVERAOE <br />NAIC a <br />w. <br />INSUPERA:Non rofita Ins Alliance Of Ca <br />11845 <br />INSURED <br />South County Outreach <br />7 Whatney Ste B <br />Irvine CA 92618 <br />INSUMEAR:IJIMPloysurs, Preferred In. CO <br />10346 <br />INSURERC: <br />INSURERDI. <br />INMUREREv <br />INSURER F: <br />nnvERAGER CERTIFICATE NUMBER:20-21 NTAC-E6 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />INTR <br />TYPE OF INSURANCE <br />ODL <br />OBR <br />POLICY NUMBER <br />POLICYEFF <br />MMIDD/VWY <br />POUOY E%P <br />D V <br />LIMITS <br />H 1 <br />COMMERCIAL GENFAALLIABILITY <br />EACH OCCURRENCE <br />S 11000,000 <br />A <br />CLAIM6-MADE O OCCUR <br />AMAGE R- <br />PREMISES Ee owurcenoa <br />S 500, 000 <br />MED E%P(AnY one 2.12PI <br />$ 20,000 <br />X <br />Y <br />2020-22015 <br />11/1/2020 <br />11/1/2021 <br />PERSONAL &ADV INJURY <br />$ 11000,000 <br />GENt AGGREGATE LIMITAPPLIESPER: <br />GEN ERAL AGGREGATE <br />$ 2, 000, 000 <br />PRODUCTS m COMPIOPAGG <br />Is 21000,000 <br />X POLICY jEOi I'm <br />S,wft; <br />$ 1,000,000 <br />OTHER:EmPleYse <br />AUTOMOBILE LIABILITY <br />COMBINERS 0 IT Ea ..d.01 <br />a 1,000,000 <br />BODILY INJURY (Per NKOO) <br />a <br />A <br />X ANYAUTO <br />ALLSCHEDULED <br />OS OWNED <br />NON-0VANED <br />X HIRSDAAUTOS UT08 X AUTOS <br />2020-2201E <br />11/1/2020 <br />11/1/2021 <br />Ba0 ODILY INJURY (PM ttlgnll <br />a <br />PROPERN DAMAOL- <br />Pet aceldenl <br />$ <br />Unmsumd Matt enticed single <br />_ <br />$ 1,000,000 <br />UMaRELLALIAR <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE ,. <br />a <br />EXOBSSLIAB <br />CLAM -MADE <br />- <br />ICED I IFETENTIO <br />Is <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERW LIABILITY ANY <br />ANY PROPRIETDR/PARTNWVI ECUTIVE Y/N <br />OFFICERIMEMaER EXCLUDED? In <br />(Mandatary In NH) <br />NTA <br />EI82T391aS02 <br />11/1/2020 <br />11/1/2021 <br />Y OTH <br />E ER <br />E.L. EACH ACCIDENT <br />s 11000,000 <br />EL DISEASE -EA EMPLOYEE <br />$ 1 000 OOD <br />E.L. DISEASE POUCV LIMIT <br />is 11000,000. <br />D SG IPTIOe undol <br />DESCRIPTIONO d&RA 10 Sbubw <br />A <br />PBOPD9SICNAL LIABILITY <br />2020-22015 <br />11/1/2020 <br />11/1/2021 <br />EACH PROFINCIOeNT UMn $1,000,000 <br />AGGREGATEUMIT $2,000,000 <br />DESCRIPTION OF OPERATIONS i LOCATIONS / VEHICLES (ADORD III, AddIlangl Remade SCM1eduI%muy W.Ugshad If more spore Is rgqulrod) <br />CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED/PRIMARY AND NONCONTRIB➢TORT PER ENDORSEMENT NTAC-E61 0219. <br />WAIVER OF S➢IXOOATION APPLIES PER ENDORSEMENT NTAC-E26 1117 WHEN AGREED TO BY WRITTEN CONTRACT OR AGREEMENT. <br />POLICY CONTAINS 30 DAY CANCELLATION CLA➢SE. 10 DAYS NOTICE IN THE EVENT OF CANCELLATION FOR NON-PAYMENT, <br />*City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this <br />policy pursuant to Written contract, agzsemernt, or memorandum of understanding. Such insurance as is <br />afforded by thia policy shall be primary, and any insurance carried by City sball be excess and <br />noncontributory. <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />AUTHORIZED REPRESENTATIVE <br />Campbell/CC <br />ACORD 2612014101) The ACORD name and ]ago are registered marks of ACORD I i k,. <br />INS026 (20140) Rnk Manaoel <br />