SANTA ANA BOYS AND GIRLS CLUB - 2014

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CERTIFICATE OF LIABILITY INSURANCE 05 /13 /2014 Y) 05/13/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 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 1- 909 - 243 -8200 Hays of California Insurance Services - Ontario CONTACT NAME: PHONE ,909- 243 -8200 FAX AC No: 909- 243 -8201 N. ADDRESS: Empire Towers IV 3800 Concours, Suite 3400 PRODUCER Ontario, CA 91764 CUSTOM RID INSURERS AFFORDING COVERAGE NAIC# Kelly Peterson INSURED INSURERA: PHILADELPHIA IND INS CO 18058 Boys & Girls Club of Santa Ana Boys & Girls Club of Santa Ana Foundation INSURERS: PROCENTURY INS CO 21903 INSURER C: 250 N. Golden Circle Dr., Ste. 104 INSURER D: Santa Ana, CA 92705 PERSONAL &ADV INJURY INSURER E: NSURER F COVERAGES CERTIFICATE NUMBER: 39683439 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS A GENERAL LIABILITY USA PHPK1133171 02/11/1 02/11/15 EACHOCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY PREMISES( RENTED PREMISES RENT rrence $ 100,000 MED EXP(Any one person) $ 51000 CLAIMS -MADE OCCUR PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGO $ 3,000,000 X POLICY PRO- LOC $ A AUTOMOBILE X LIABILITY ANY AUTO PHPK1133171 02/11/1 02/11/15 COMBINED SINGLE LIMIT (Ea eccltlani) $ 11000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ $ NON -OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA WCMPRO 5073889 O6 /O1 /1 06/01/14 X WC STATU- OTH- L E. L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 1, 000, 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) i� FORM RE: Expansion campaign - Storage of 13GCSA bus on Santa Ana City Corporate�8} City of Santa Ana, its officers, employees, agents, volunteers and repress tat .ves a n Ed dditional ured as respects General Liability; 3ose Sandova Primary and non - contributory wording is included as respects General Liaba i y; Assistant City AttOTney S a CERTIFICATE HOLDER CANCELLATION / / City of Santa Ana SHOULD ANY OF V E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92701 �p USA ngarcia_hays © 1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD 39683439