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CERTIFICATE OF LIABI
<br />IMmG Dig
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGH UPON THE CER- IF.�.,y E L I
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR All THE COVERAGE AFF PJED GyCJVLF .O6.21
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT I�E/'��Tp` j'0� (ol,: I I n
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. V �. �,A �,J 10:50-45-071001
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SU3P JGATION 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 endomement(s).
<br />Wigmore Insurance Agency Inc.
<br />880 W. 19th St.
<br />'License #0811959
<br />Costa Mesa CA 92627
<br />INSURED
<br />Orange County Bar Foundation Inc
<br />1605 E. 17th Street
<br />NAME: Ken Noden, CPCU
<br />-6543
<br />PHONE (714)979
<br />LAIC. No. Extl: m I. p141549-e943
<br />.com
<br />Santa Ana CA 92705 1INSURER F
<br />COVERAriPR CFRTIPIf1ATP MIIIMOCo."/9R aT.T. TTwmc .,�.......... ..........�
<br />THIS IS TO CERTIFY THATTHE 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ILICY
<br />LTR SR
<br />TYPE OF INSURANCE
<br />DD
<br />9UBR
<br />POLICYNUMBER
<br />MMIDPOLIONYYYI YEFF
<br />E�
<br />MMIDONYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000, 000
<br />OERE TED
<br />PRREMIEMISESS Ea omurrence
<br />$ 100,000
<br />MED EXP Anyoneperson)
<br />S 5,000
<br />X
<br />Y
<br />PHPK2391127
<br />3/15/2022
<br />VM/2023
<br />PERSONAL BADV INJURY
<br />$ 1,000,000
<br />GENL AGGREGATE LIMITAPPLIES PER:
<br />X POLICY ❑ PRO- ❑
<br />JECT LOC
<br />GENERALAGGREGATE
<br />IS 2,000,000
<br />PRODUCTS-COMPlOPAGG
<br />$ 2,000, 000
<br />$
<br />OTHER.
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />a celdanfi
<br />$ 1,000,000
<br />BODILY INJURY (Per ameon)
<br />$
<br />AIx
<br />ANYAIfTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />X
<br />Y
<br />1?11 2391127
<br />3/15/2022
<br />3/15/2023
<br />BODILY INJURY ( )
<br />$
<br />HIREDAUTOS X NON-0WNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />Per ci
<br />$
<br />IS
<br />1
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 3,000, ODD
<br />AGGREGATE
<br />$ 31000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />OED I I RETENTION $ 10,000
<br />$
<br />X
<br />Y
<br />PHUB807012
<br />3/15/2022
<br />3/15/2023
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YINATUTE
<br />ANY PROPRIETOWPARTNERIEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? �
<br />(Mandatory In NH)
<br />If yes, describe under
<br />NIA
<br />EIG1121780-13
<br />1/1/2022
<br />1/1/2023
<br />X PER OTH-
<br />ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000 000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1 000 000
<br />DESCRI PTION OF OPERATIONS below
<br />A
<br />PSOfessional Liability
<br />PHP12391127
<br />3/15/2022
<br />3/15/2023
<br />Each Incident Limit $1,000,000
<br />AggmOale Limit $2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 401, AEEIOonal Remarks Schedule, may be attached if more space is required)
<br />The City of Santa Ana, Its Officers, Employees, Agents, Volunteers, and Representatives are named as
<br />additional insured_ ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE per form PI-GL-005 (07/12).
<br />City of Santa Ana
<br />Lisa Rudloff Executive Director Parks,
<br />Recreation and Community Services Agency
<br />20 Civic Center Plaza
<br />P O Box 1988
<br />Santa. Ana, CA 92702-1988
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />wigmore/K140
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />INS025 (201401)
<br />RLkM�agemmtDM$fDR
<br />+9' REMEWID&APpp/o1VEO Sr.
<br />14
<br />- Risk Management Spedalls[ ..
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