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ACORD,, CERTIFICATE OF LIABILITY INSURANCE <br />ATE (MM DOlYYYYy <br />DATE <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 2 50 <br />RSM, CA 92688 <br />NAME: <br />_ <br />PHONE (949)709-8800 i Arc Na}: (949)709 -1668 <br />A!C No Exl : <br />ADDRESS: J�Y <br />........._- <br />._..._ <br />--_ ------._- . <br />j INSURER(S) AFFORDING COVERAGE NAIC N <br />INSURER A; NONPROFITS' INSURANCE ALLIANCE OF CA <br />INSURED Community Action Partnership of <br />Orange County <br />11870 Monarch St. <br />Garden Grove, CA 92841 <br />_ <br />INSURER 8: ICW GROUP INSURANCE COMPANIES f <br />INSURER C: NATIONAL UNION FIRE INS CO <br />----- - - - - -- - -- -- -- ._.....--°.--.....-_......_. __.._..._. ............... ... .T. <br />INSURER D: <br />_ <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: GL /AUTO /UMB <br />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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CDND1710NS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />iLTR <br />TYPE OF INSURANCE <br />INSR WVD <br />POLICY NUMBER <br />MMIDDIYYY <br />MMIDONYYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />` X I COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADE Fx OCCUR <br />1 Contr. Pro <br />I <br />X i <br />2012- 00441 -NP <br />I <br />I <br />07/01/2012 <br />I <br />i <br />07101120131 <br />I <br />j <br />EACH OCCURRENCE S 1,400,00 <br />PREMISES (Ea occurrenceL�',� S S00,000 <br />MED EXP(Any one person) <br />$_ 20,400 <br />PERSONAL&ACV INJURY_ <br />GENERAL AGGREGATE <br />$ 1,000,00 <br />$-- <br />1 <br />__.._._.._- .__..... <br />BTE <br />E 'LOAGGREG MI <br />F-1 APPLIES PER <br />F71 POLICY PRO JECT X LOC <br />I <br />PRODUCTS - COMPIOP AGG <br />- ___. -2,000,000 <br />$ 2,000,000 <br />$ <br />AUTOMOBILE <br />LIABILITY <br />2 0 1 2- 00441 -NP <br />07101/2012 <br />0710112013; <br />, (Ea aadenl i <br />I $ 1,000,000 <br />--- _--- - - - -�. <br />'4 <br />X <br />X <br />I ANY AUTO <br />ALL OWNED r"" -1 SCHEDULED <br />AUTOS _ !AUTOS <br />i--� NON -OWNED <br />i HIRED AUTOS X AUTOS <br />i <br />I <br />� <br />I <br />°BODILY INJURY (Per person) <br />' <br />is <br />i BODILY INJURY (Per acvder� <br />) <br />$ <br />(Per accident <br />$ <br />- <br />$ <br />A <br />I <br />1 UMBRELLA LIAR X I OCCUR <br />EXCESS L1AB I CLAIMS -MADE. <br />2012- 00441- UMB -NPO <br />07101120121 07/0112013 <br />EACH OCCURRENCE <br />$ 4,000,000 <br />AGGREGATE <br />$ 4, QQQ i QQQ <br />DED X J RETENTION$ 10,00 <br />$ <br />B <br />a <br />WORKERS COMPENSATIN AND £MPLO ERS' LIABILITY YIN <br />AN Y PROPRIETORIPARTNERtEXECUTN <br />O CERI BER EXCLUDED? <br />IM Manatoy ln NH <br />5Nbe <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />WPL50214090d <br />l <br />07101/2012107/0112013 <br />X ! TORY LIMITS -1 ER <br />- -- - -- <br />EL_ EACH - ACCIDEN <br />EL. DISEASE - EA EMPLOYE <br />- 1, 000 , 00 <br />$ 1, OOO , OO O <br />E.L. DISEASE - POLICY LIMIT j <br />$ 1,000,000 <br />1 C )DISHONESTY <br />� - EMPLOYEE <br />02- 420 -32 -32 <br />07101/2012i07/0112013 <br />LIMIT $1,100,000 <br />DEDUCTIBLE $5,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) <br />ITY OF SANTA ANA IS INCUDED AS ADDITIONAL INSURED PER ATTACHED SPECIAL AGREEMENT <br />�R� Q <br />____ _ .� .vr.. •...v�v �.� VMIN �rCLLHI IVIN -.19— - _VIA. " <br />THE CITY OF SANTA ANA <br />SANTA ANA YOUTH COUNCIL <br />WORKFORCE INVESEMENT BOARD <br />1000 E. SANTA ANA BLVD_ <br />STE. 200 <br />SANTA ANA, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL eE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />non. CIC /JER <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />19F -220 <br />All rinhtS rP.SPNP_rI. <br />