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A?RDs CERTIFICATE OF LIABILITY INSURANCE <br />YYY) <br />,ti28M <br />00 <br />9n <br />- 20 <br />0 <br />PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION <br />MARSH RISK & INSURANCE SERVICES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />SAN FRANCISCO, CA 94014 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />CALIFORNIA LICENSE NO. 0437153 and <br />NonProfits' U <br />lt <br />d W <br />k <br />' C <br />G ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />n <br />or <br />e <br />ers <br />omp <br />roup <br />431 1 Street, Suite 200, Sacramento Ca 95814 <br />398879-WC-XSWC-09-10 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED <br />Orange County Conservation Corps <br />INSURERA. NonProBts' Unlted Workers' Compensation -- <br />1853 North Raymond Avenue INSURER B: ACE American Insurance Company 22667 <br />Anaheim <br />CA 02801 <br />, NSURERC: <br /> INSURER D: <br /> INSURER E: <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE <br />MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND <br />CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />NS <br />L7R ADD' <br />INSR TYPE OF NSURANCE POLICY NUMBER PDOCYEFFELTNE POLIOVEMIZATION <br />LIMITS <br /> DATE(M VDIYYYY) DATEIMM10ORYfY7 <br /> GENERAL LIABILITY EACH OCCURRENCE <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED <br /> <br />PREMISES Eaoccvrreoce $ <br /> ?I <br />CLAIMS MADE LJ OCCUR MEDEXPLAVJDnepermn) $ <br /> PERSONAL S ADV INJURY $ <br /> <br /> <br />GE <br />NERAL AGGREGATE LIMIT APPLI ?` V <br />to GENERAL AGGREGATE $ <br /> ES PER <br />PRO <br />- PRODUCTS - CON P10P AG <br /> POLICY <br />LOC <br />JECT <br /> AUT OMOBILE LIABILITY ?- <br />po/ <br />G? <br />COMBINED SINGLE LIMIT <br /> <br />$ <br /> ANYAUTO p(??'g i• ( t/Le <br />? <br />D <br />i` (Ea ecddenl) <br /> ALLOWNEDAUTOS •- <br />P " <br />iy P <br />' BODILY INJURY $ <br /> SCHEDULEDAUTOS G <br />?5 G (Per person) <br /> HIREDAUTOS -o <br /> ^Slo BODILY INJURY $ <br /> NON-OWNEDAUTOS (Pereuldanl) <br /> PROPERTY DAMAGE <br /> -- (PereccBenl) $ <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO OTHERTHAN EA ACC <br /> AUTOONLY: $ <br /> AGG <br /> EXCESS I U MBRELLA LIABI L RY EACHOCCURRENCE $ <br /> OCCUR CLA%ISMADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> $ <br /> <br />RETENTION $ _ <br />A WORKERS COMPENSATION AND NPU-WCGO01-2010 01101/2010 01101/2011 WCSTATU- XoTH- <br /> EMPLOYERS' LIABILITY <br /> ANY PROPRIETORIPARTNER,EXECUTIVE YIN <br />OFF <br />C E .LEACHACCIDENT SOO,000 <br /> I <br />RRdEMBER EXCLUDED? <br />.L DISEASE - EA EMPLOYE <br />IS 500,000 <br /> 1AUrMabry In NH)11 es, tlescnbe antler <br />SPECIAL PROVISIONS Eebv .L DISEASE <br />POLICY UNIT <br />$ 500,000 <br /> OTHER <br />B Excess Workers'Compensalion WCLC45712709 01/0112010 01/0112011 $35,000,000 x$500,000 WC <br /> $2,000,000 x $500,13DO EL <br />DESCRIPTION OF OPERATIONWLOCAVONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENNSPECIAL PROVISIONS <br />CERTIFICATE HOLDER SFA-nnisgn491-nt CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />City of Santa Ana EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />Workforce Investment Board 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />P. O. Box 1988 M-73 <br />Santa Ana, CA 92702 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND <br /> UPON <br />THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br /> FA 9F <br />A0?MarS USAPIncBDrtATNE - y <br /> Pa[ Clark ACOHU 25 (ZUU9/01) - ®1998.2009 ACORD CORPORATION. All Rights Reserved <br />The ACORD name and logo are registered marks of ACORD