LUTHERAN SOCIAL SERVICES OF SOUTHERN CALIFORNIA (3)

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�1 m Tori Digitally signed by Ton Pierson Pierson Date: 2021.07.21 15:54:20-07'00' �coRO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODNYYYI 07/0212021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and Conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NTAC A DeJohn NAME: Carriage Trade Insurance Agency, Inc PNONa (518) 358-5800 518 )35 alc Nat ( &5858 99 Tulip Avenue ADDRESS: ADeJohn@CamegeTradelnsurance com Suite 404 IN9URFTt(5)AFFOROING COVERAGE NAICtl Floral Park INSURERA: Wesee Insurance Co. 25011 NY 11001 INSURED INSURERS: Lutheran Social Services of Southern California INSURER C: 247 EAmerige Ave, Fullerton, CA 92832 INSURER D: INSURER E: Fullerton CA 92832 INSURER F: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERN OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TOALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILTR TYPE OF INSURANCE IN9D O POLICVNUMBER M MM� LIMITS x COMMERCIAL GENERAL ASLITY EACH OCCURRENCE S 1,000,000 CLAIMS -MADE �l OCCUR PREMISES Eamismance S 100,000 I MED CUP (Any one par son) S 5.000 A PERSONAL SAUV INJURY S 1,000,000 Y WPPI 86062601 07/01/2021 07/01/2022 GEN'LAGGREGATE LIMITAPPUES PER: GENERALAGGREGATE S 3.000,000 PRODUCTS -COMPIOPAGG S 3.000,000 POUCY 0 JELT LOC OTHER Employee Benefits S 1,000,000 AUTOMOBILELMBILITY BINED LE LIMIT Ea amidam S 1.000,000 X ANYAUTO BODILY INJURY(Perperson) S A OWNED SCHEDULED AUTOS ONLY AUTOS VVPPl 860625 of 07/D7/2021 07/01/2022 BODILY INJURY (Per saddens 5 HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY E Per somNm S Medical Expense S 5,000 X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 3,000,000 AGGREGATE y 3,000,000 A EXCESS LIAR CLAIMS -MADE WUM 186635201 07/01/2021 07/)1I2022 DEC RETENTION S 10.000 WORKERS COMPENSATION PER OTH- S ANDEMPLOYERS'LIABILITY YIN STATUTE Eft EL EACH ACCIDENT S ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ NIA IMarldataryia NH) It yes, desmbe under EL DISEASE - EA EMPLOYEE S EL DISEASE -POLICY OMIT S CESCRIPTION OF OPERATIONS sA. DESCRIPTION OF OPERATIONS LOCATIONS / VEHICLES (ACORD 101, Additianal Remarks Schedule, may be attached it mom Besse is required) City of Santa Ana, officers, agents, employees, and Volunteers are induced as Additional Insureds as with respect to work performed by the Named Insured as required by written contract, agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be Primary, and any insurance carved by City shall be excess and noncontributory Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana ACORD 26 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE e�na.b. IWeMooBMaad Dfsium its.. APPINOVEDBY. ©1988-2015 ACORD ( ( %psf rlLTJOH The ACORD name and logo are registered marks of ACORD �RmrN+Vrvgenv,maaialadz CA 927U2