LUTHERAN SOCIAL SERVICES OF SOUTHERN CALIFORNIA (3)

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ACC o® CERTIFICATE OF LIABILITY INSURANCE DA oaMMMDY) 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(ies) 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 CONTACT Elsy Fuentes NAME Commercial Management Insurance Services Inc. PHONE (714) 414-1167 FA (714) 414-1198 AIC No Ext: AIC, No: CA License OD85858 L-MAIL ADDRESS: elsy@cmis-ins.com 751 S Weir Canyon Rd, 157-355 INSURER(S) AFFORDING COVERAGE NAIC # Anaheim CA 92808 INSURERA: Redwood Fire 8 Casualty 11673 INSURED INSURER B : Lutheran Social Services Of Southern California INSURER C: DBA LSS Community Care INSURER D: 247 E. Amerige Ave. - INSURER E: Fullerton CA 92832 INSURER F: UIUVEKAUES CERTIFICATE NUMBER: 2UXI REVISION NUMBER' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD MD POLICY NUMBER MM/DDIYYYY XP MWDDYIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE Is DAMAGE TO RENTEU, PREMISES(Ea occmrence $ CLAIMS -MADE 0OCCUR MED EXP (Any one Persom PERSONAL B ACV INJURY $. GEN'L AGGREGATE U MIT APPLIES PER: PRO- POLICY ❑ PRO- ❑ OC GENERALAGGREGATE $ PRODUCTS-COMP/OPAGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AMOS ONLY AUTOS 1 BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY H PROPERTY DAMAGE Per amident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION PER OTH- X I AND EMPLOYERS' LIABILITY YIN STATUTE Eft E.L. EACH ACCIDENT $ 1,000,000 A ANY PROPMETOR/PARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA LUWC217692 01/01/2021 01/01/2022 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, descdbe under DESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) EVIDENCE OF INSURANCE COVERAGE CITY OF SANTAANA RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLAZA SANTAANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Rhit Mmgand Diwim r "a,"4 IRNeLID6Arrxovm Br. CA 92701 V 18B8-ZU15 AUUKU ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD