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HUMAOPT -04 HEFBRI 44c°j?O CERTIFICATE OF LIABILITY INSURANCE DATD 1 0/2121z/zo12 _ THIS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # 0564249 (OC) Heffernan Insurance Brokers Hutton Centre Drive, Suite 500 Santa Ana, CA 92707 CNAONME: TA CT PHONE 1 (714) 361 -7700 ac : 1 (714) 361 -7701 AIC No rt He Exit E -MAIL ADDRESS;_. _ INSURER(S) AFFORDING COVERAGE NAICIs INSURER A: Great American Insurance Company_ INSURED INSURERB: Great American Alliance Insurance Company 26832 'INS URER C: Human Options !INSURER D: 5540 -A Trabuco Road Irvine, CA 92620 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, - EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS- LTRi TYPE OFINSURANCE IN SR WVD POLICYNUMBER POLICY EFF MMIODMW POLICY EXP MAID YYYY LIMITS A i GENERAL LIABILITY A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR x PAC1669863 9123/2012 912312013 EACH OCCURRENCE $ 1,000,000 PREMISES Eaoccurrence $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 G ENE RAL AGGR EGAT E $ 2,000,000 G EVIL AGO REGATE LI M IT APPLIES PE P PRODUCTS - COM PIOP AGO $ 1,000,000 JZC POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1000,000 $ , BODILY INJURY (Per person) .s A ANY AUTO PAC1669863 9/2312012 9123/2013 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ ! X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accitlent $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 4,000,0001 B EXCESS LIAR CLAIMS -MADE UMB1669864 912312012 9/2312013 AGGREGATE $ 1 DEB X RETENTION$ 10,000 $ 4,000,000 WORKERS COMPENSATION VJC STATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERNEMBER EXCLUDED? NIA T RY LIMIT ER EL EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE$ i(Mantlalory In NH) If yes, eescdbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ • Prof. Liability [PAC1669863 9123/2012 912312013 Occurrence 1,000,000 • Sexual Misconduct PAC1669863 9123/2012 912312013 Occurrence 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Li Project: Funding to provide counseling services in the City of Santa Ana. City of Santa Ana, its officers, employees, agents, volunteer �'Lrpresentati es are named as additional insured (primary) on General Liability policy per attached endorsement. 40�S �� N �(? sip tt0l�wl AgP od / CERTIFICATE HOLDER CANCELLATION \Sta _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana Attn: Frank Hernandez THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza { U ORIZED REPRESENTATIVE I Santa Ana, CA 92707 n I / J ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD