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<br />ORANCOU -07 PATRA5
<br />1coR6 CERTIFICATE OF LIABILITY INSURANCE
<br />DAT DIYYYY)
<br />7//1 1812 812 012
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION 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 endorsement(s).
<br />PRODUCER License # 0522024
<br />CONT: CT y
<br />NAME
<br />PHONE., 1 (626) 405 -8031 n/c No .1 (626 }05 -0585
<br />Arc N El
<br />Chapman
<br />PO Box 5455
<br />Pasadena, CA 91117 -0455
<br />ADDRIESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Great American Insurance Company
<br />1691
<br />INSURED
<br />INSURER B: Non Profits United
<br />INSURERC:
<br />Orange County Conservation Corps
<br />INSURER D:
<br />1853 N. Raymond Ave.
<br />INSURER E:
<br />Anaheim, CA 92801 ,yy
<br />A- �Of�l1�°
<br />INSURERF: -
<br />_
<br />h
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE 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 />j 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSR
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />(MM/DD
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE a OCCUR
<br />X
<br />PAC5154680 -07
<br />7/20/2012
<br />7/20/2013
<br />PREMISES Ea occur ante
<br />$ 100,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />X Professional $1 M
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />X
<br />Abuse $1M
<br />GENERAL AGGREGATE
<br />$ 3,000,000'
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP /OP AGG
<br />$ 3,000,000
<br />POLICY PRO LOC
<br />JECT
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />—1
<br />BODILY INJURY (Per person)
<br />$
<br />B
<br />AN Y AUTO
<br />1560
<br />7/1/2012
<br />7/1/2013
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />JX
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED AUTOS r NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE,
<br />DED I I RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR /PARTNER /EXECUTIVEYlN
<br />OFFICER /MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />NPUWCGO012012
<br />1/1/2012
<br />1/1/2013
<br />X WC STATU- OTH-
<br />TORY LIMITS I I ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000'
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1 $ 1,000,000'
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />The City of Santa Ana, its officers, agents, employees and volunteers, and the State of California, its officers, employees, and volunteers are Itional
<br />;insured /Funding Source with respect to the operations of the named insured per the attached CG 2026 endorsement. Such insuranctisf�ilyla
<br />Non - Contributory. Workers Compensation coverage excluded, evidence only. Ov�D A +v
<br />SIORGK
<br />-- L 5sA t City AttOCvie'l
<br />CERTIFICATE HOLDER
<br />CANCELLATION AS s
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City Of Santa And, Workforce Investment Board
<br />1000 E. Santa Ana Blvd., Ste. 200
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />©1988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
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