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Francine R. 'Villareal
<br />signed by Francine R.
<br />A-2021-107-056
<br />Villareal Date: 2021.08.1010:47:45
<br />-07'00'
<br />� oRae CERTIFICATE OF LIABILITY INSURANCE
<br />-DATE(MMMDNYW)
<br />7/28/2021
<br />THIS CERTIFICATE IS ISSU ED 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 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(les) must be endorsed. It 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 endorsoment(s),
<br />PRODUCER
<br />Conray Ina Brokers & Risk Managers
<br />2522 N. Santiago Blvd.
<br />LiCN0543173
<br />Orange CA 92067
<br />NAME) Christine Campbell
<br />PHONE (877)450-1872 FAX 171q es0-plea
<br />At' q:
<br />Wool ss: christinec@donrayins,com
<br />INSURER a AFFORDING COVERAGE
<br />NAIC q
<br />IMSURERAINon rofits Ins Alliance Of -Ca
<br />11845
<br />INSURED
<br />South County Outreach
<br />7 Whatmay Ste B
<br />Irvine CA 92610
<br />INSURERS I MIS1012yers Preferred Iris CO
<br />10346
<br />INSURERCI
<br />INSURERD: --
<br />INSUREREI
<br />INaURERP:
<br />.COVERAGES CERTIFICATE NUMBER:20-21 NIAO-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 OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO 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 />NN
<br />IlT0.
<br />TYPE OF INSURANCE
<br />ADDL
<br />WVrL 3UDR
<br />pOLIGy NUMBER
<br />POLIbY WY
<br />MMIO�YIYVVP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILItt
<br />CLAIME-MADE OCCUR
<br />RENCE
<br />$ 11000,000
<br />e cca nonce
<br />a 500,000
<br />y ane ereoR
<br />20,000
<br />X
<br />Y
<br />2020-22015 -
<br />11/1/2020
<br />it/L/2D21
<br />ADV INJURY
<br />!JALN!
<br />$ 1,000,000
<br />GEMLAGGREGATE UMITAPPUE$ PER:
<br />POLICY Lao
<br />JECTOTHER:
<br />REGATE
<br />$2,000,000
<br />COMWOPAGG
<br />$ 21000,000
<br />EmployeenO
<br />S 1,000,000
<br />AUTOMOBILELIABU.ITY
<br />OMDINED SINGLELIIT
<br />e
<br />Ea Wd 1
<br />$- 11000,000
<br />GODILY INJURY (Per person)
<br />$
<br />A
<br />X
<br />ANYAUTO
<br />U AUTOSSCHEDULED
<br />AUTOLL OWNED
<br />2020-22015
<br />11/1/2020
<br />11/L/2021
<br />BODILY INJURY (Pergccldont)
<br />$
<br />X
<br />X NON -OWNED
<br />HIREDAUPS AUTOS
<br />PROPERTY DAMAGE
<br />oracedonl
<br />$
<br />Uninsured,wlorldmwweae sia,le
<br />$ 1, 000,000
<br />UMSRELLAUAs
<br />OCCUR
<br />EACH OCCURRENCE
<br />g
<br />AGGREGATE
<br />$
<br />EXCESSUAS
<br />I CLAIMS-MAPE
<br />BED I I RETENTION $
<br />-
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETOR/PARTNEWEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? Fig
<br />(Mandatory In NH)
<br />HY¢6, l{BSCdbO under
<br />DESCRIPTION OF OPERATIONS Why,
<br />MIA
<br />—273013002
<br />11/1/2020
<br />11/1/2021
<br />y PER OTH-
<br />I STATUE E
<br />E.L. EACH ACCIDENT
<br />$ 1,000 000
<br />E.L. DISEASE - CA EMPLOYEE
<br />$ 1 000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />PROPESSIONAL LIABILITY
<br />2020-22u15
<br />11/1/2020
<br />11/1/2D21
<br />EACH PROF- INCIDENT LIMIT $1,000,000
<br />AGGREGATELIMIT $2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES (ACORD 101, Addltlonal Remarks schedule, may be RUAGhod if ....Pa.. is required)
<br />CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED/PRIMARY AND NONCONTRIBUTORY PER ENDORSENENT NIAC-E61 0219.
<br />WAIVER OF SUBROGATION APPLIES PER ENDORSEMENT NIAC-E26 1117 WHEN AGREED TO EY WRITTEN CONTRACT OR AGREEMENT,
<br />POLICY CONTAINS 30 DAY CANCELLATION CLAVEE. 10 DAYS NOTICE IN THE EVENT OF CANCELLATION FOR NON-PAYMENT,
<br />*City of Santa Ana, OffiOera, agents, employees, and volunteers are reamed as additionally insured on this
<br />policy pursuant to written contract, agreement, or memorandum of 1lnderatanding. Such insurance as is
<br />afforded by this policy shall be primary, and any insurance carried by City shall 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 />Campbell/CC
<br />ACORD 25 (2014)01) The ACORD name and logo are registered marks of ACORD
<br />INS025 (201401)
<br />RISISh)aPggvinwdDnfAion ..
<br />rft rrR!EVIEWED& rA�PPPROVED B/
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<br />�Risk ManageR?eri[Ana�st.=
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