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4 <br />HUMAOPT -04 HBCT05 <br />CERTIFICATE OF LIABILITY INSURANCE <br />DA31292013 ) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />ERTIFICATE 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 endomement(s). <br />PRODUCER License S 0564249 <br />CONTACT <br />PHONE 1 714 361 -7700 FAX <br />AIC No Es* ( ) Atc Na: 1 (71 4) 361 -7701 <br />(OC) Heffernan Insurance Brokers <br />88 Hutton Centre Drive, Suite 500 <br />Santa Ana, CA 92707 <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURER A: New York Marine B: General Insurance <br />16608 <br />INSURED <br />INSURER B <br />INSURER C <br />HUMAN OPTIONS <br />INSURER D: <br />5540 -A Trabuco Road <br />INSURER E: <br />Irvine, CA 92620 <br />INSURER F: <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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ISSUBJECTTOALLTHE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />rypE OF INSURANCE <br />IN SR <br />UB <br />MD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY EXP <br />MMIDD/YYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br />PREMISES Ea occurrence <br />$ <br />COMMERCIAL GENERAL LABILITY <br />CLAIMS -MADE ❑ OCCUR <br />MED EXP (Any one person) <br />$ <br />PERSONAL It ADV INJURY <br />$ <br />GENERAL AGGREGATE <br />$ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP /OP AGG <br />$ <br />i <br />$ <br />POLICY PRO LOC <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />BODILY I NJURY(Per person) <br />$ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />PER ACCIDENT <br />$ <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />EXCESS LIAR <br />CLAIMS -MADE <br />AGGREGATE <br />$ <br />DED RETENTION$ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />A <br />ANY PROPRIETORIPARTNERIEXECUTIVEYL <br />WC291300001245 <br />4/112013 <br />41I2074 <br />X WC STATU- OTH- <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />OFFIGERIMEMBER E %C W DED? <br />(Mandatory In NH) <br />NIA <br />E.L. DISEASE -EA EMPLOYE <br />$ 1,000,000 <br />Use, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) <br />Project: Funding to provide counseling services in the City of Santa Ana. <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attn: Frank Hernandez <br />20 Civic Center Plaza <br />AUUT REPRESENTATIVE <br />Santa Ana, CA 92701 <br />/HORRED <br />li1L- <br />© 1988.2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />