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ACORD, CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDIYYYY)
<br />TYPE OF INSURANCE
<br />07/03/2012
<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
<br />Comprehensive Insurance Services
<br />22342 Avenida Empresa
<br />Suite 250
<br />RSM, CA 92688
<br />NAME
<br />PHONE
<br />a No E t1: (949)709 -8800 ac Nol: (949)709-166
<br />..ADDRESS-.
<br />INSURER(S) AFFORDING COVERAGE
<br />NAICtl
<br />_
<br />INSURER A: NONPROFITS' INSURANCE ALLIANCE O
<br />CA
<br />INSUREb Community Action Partnership o€
<br />Orange County
<br />11870 Monarch St.
<br />Garden Grove, CA 92841
<br />INSURERS: ICW GROUP INSURANCE COMPANIES
<br />'
<br />INSURER C: NATIONAL UNION FIRE INS CO
<br />! MED EXP (Any one person)
<br />PERSONAL S ACV INJURY
<br />INSURERD:
<br />INSURER E:
<br />$ 2,000,000
<br />INSURER F;
<br />THIS IS TO CERTIFY THAT THE POLICIES CF 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />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 />LTR
<br />TYPE OF INSURANCE
<br />INSR
<br />WVD
<br />POLICY NUMBER
<br />(MMIDWYYYY) f (MMIDDIYYYYJ
<br />I LIMITS
<br />A
<br />GENERAL LIABILITY
<br />` :=T COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE L 11 OCCUR
<br />; X Owner & Contr. Pro
<br />i
<br />I X
<br />'
<br />2012 -00441-NPI
<br />I
<br />07/0112012 07/01/2013
<br />i
<br />j 3
<br />EACH OCCURRENCE
<br />Is 1,00-01000
<br />PREMISES (Ea occurrence)
<br />$ 500, 00
<br />! MED EXP (Any one person)
<br />PERSONAL S ACV INJURY
<br />$ 20,000
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GENL AGGREGATE LIMIT APPLIES PER:
<br />POLICY [_-] PRO-
<br />JECT X LOC
<br />PRODUCTS - COMPIOP AGG
<br />$ 2,000,000
<br />I
<br />1
<br />$
<br />A
<br />AUTOMOBILE
<br />X
<br />I
<br />X
<br />LIABILITY
<br />1 ANY AUTO
<br />ALL OWNED _ SCHEDULED
<br />AUTOS AUTOS
<br />NON-OWNED
<br />HIRED AUTOS rx AUTOS
<br />2012-00441-NPC
<br />07101/2012 07/01/2013
<br />!
<br />I
<br />{Ea accident)
<br />I
<br />;$ 1, 000,000
<br />BODILY INJURY (Per person)
<br />----- �---
<br />IS
<br />BODILY INJURY (Per accident)
<br />---- --
<br />j $
<br />(Per acadent c
<br />- - --
<br />$
<br />$
<br />i
<br />I
<br />A
<br />UMBRELLA LIAR
<br />EXCESS LIAB
<br />x
<br />OCCUR
<br />CLAIMS -MADE
<br />2012 - 00441- UMB -NP
<br />1
<br />j
<br />07101/2012,10710112013
<br />j
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE �$
<br />4,000,000
<br />DED I X I RETENTION $ 11) r 00
<br />B
<br />i
<br />IC
<br />C
<br />AND EMPS YERS' COMPENSATION
<br />AND EMPLOYERS' LIAe1LITY YIN
<br />ANY PROPRIETCRJPARTNERIEXECUTIV
<br />OFFICERIMEMBER EXCLUDEC7
<br />(Mandatory in NH)
<br />It yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />RIME - EMPLOYEE i
<br />DISHONESTY
<br />NIA
<br />t
<br />I
<br />WPLI0214010
<br />OZ- 420- 32- 3�0
<br />0710112012 07101/2013
<br />I
<br />i
<br />7101/2 0 1 2;G7/01/2013+
<br />X TORY LIMITS ER
<br />E.L. EACH ACCIDENT
<br />$ 1 ,000,000
<br />E,L. DISEASE. EA EMPLOYE
<br />_.
<br />_
<br />$_ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT $ 1, 000, QQQ
<br />LIMIT $1,100,000
<br />DEDUCTIBLE $5,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, AddlUonal Remarks Schedule, If more space Is required) L ,
<br />CITY OF SANTA ANA IS INCUDED AS ADDITIONAL INSURED PER ATTACHED SPECIAL AGREEMENT RC'j 'TO 7n
<br />CCU
<br />L1 �aC� �,ty Attu 0
<br />IV 17000-AVIV AI VKU t VKVUKA I IVN. All nghts reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />19F -218
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE CITY OF SANTA ANA
<br />I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />SANTA ANA YOUTH COUNCIL
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />WORKFORCE INVESEMENT BOARD
<br />AUTHORIZED REPRESENTATIVE��'
<br />1000 E. SANTA ANA BLVD.
<br />STE. 200
<br />SANTA ANA, CA 92701
<br />Richard Eynon, CIC /JEREMY
<br />IV 17000-AVIV AI VKU t VKVUKA I IVN. All nghts reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />19F -218
<br />
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