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CERTIFICATE OF WORKERS' COMPENSATION COVERAGE Dec 15, 2008 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY <br /> AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br />Nonprofits' United Workers' Compensation Group THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />344 Thomas L. Berkley Way, Suite 340 COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Oakland, CA 94612 <br />Phone: (877) 551-671 7 INSURERS AFFORDING COVERAGE <br />Fax: (530)274-9871 <br />INSURED <br />INSURER A: Nonprofits' United Workers' Compensation Group <br />Orange County Conservation Corps wsuRER B: ACE USA <br />1853 North Raymond Avenue <br /> <br />Anaheim, CA 92801-1117 INSURER C: <br /> INSURER D: <br /> INSURER E: <br />COVERAGES This Certificate is not intended to speci all endorsements, coverages, terms, conditions and exclusions of the policies shown. <br />THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE AFFILIATE MEMBER NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM, OR CONDITION OF ANY CONTRACT OR OTHER DOC UMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE <br />COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS <br />SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR TYpE OF COVERAGE POLICY NUMBER POLICY <br />EFFECTIVE DATE POLICY <br />EXPIRATION DATE LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE <br /> COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fre) <br /> CLAIMS MADE OCCUR MED EXPENSE (Any one person) <br /> GENERAL AGGREGATE LIMIT APPLIES PER: SI^ <br />G +,r PERSONAL 8 ADV INJURY <br /> POLICY PROJECT LOC <br />~ <br />D ~ TO <br />1 GENERAL AGGREGATE <br /> pR~ <br />' PRODUCTS-COMPlOP AGG <br /> AUTOMOBILE LIABILITY ' <br />~ COMBINED SINGLE LIMIT <br /> ANY AUTO F <br />SA <br />~ RC <br />~ S'~~ <br />ney (Each accident) <br /> L A <br />A <br />ttOr <br />~ <br /> ALL OW NED AUTOS <br />tan ~J <br />Ci BODILY INJURY <br /> SCHEDULED AUTOS ^C <br />A-+eS15 (Per person) <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (Peraccidenq <br /> PROPERTY DAMAGE <br /> (Per accident) <br /> WC STAT X OTHER <br /> WORKERS' COMPENSATION LIMITS <br />A AND NPU-WCG001-2009 1/1/09 ]~1~)~ E. L. EACH ACCIDENT $500,000 <br /> EMPLOYERS LIABILITY E.L. DISEASE-EA EMPLOYEE $ SOO,000 <br /> E.L. DISEASE-COVERAGE LIMIT $ 5QQ,000 <br /> OTHER <br />B Excess Workers' Compensation ACE-temp0109 1/1/09 1/1/10 $2s,ooo,oooX$soo,ooowc <br /> $1,000,000 x $500,000 EL <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL/PROVISIONS <br />Evidence of Workers' Compensation Coverage: <br />CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION <br />NPUWCG-000C-041 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br /> BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL <br /> ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE <br /> HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE <br />Ci of Santa Ana <br />tY NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS <br />Workforce Investment Board AGENTS OR REPRESENTATIVES. <br /> <br />P. O. Box 1988 M-73 <br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE <br />Based on ACORD 25-S (7197) <br />