ORANGE COUNTY ASIAN & PACIFIC ISLANDER COMMUNITY ALLIANCE - 2014

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SPECSER-01 MERCHANTAI 144c"Rte'' CERTIFICATE OF LIABILITY INSURANCE DATE 11/13/2013 11/13/2013 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 Willis Insurance Services of California, Inc. c/o 26 Cantu ry Blvd, P.O. Box 305191 Nashville, TN 37230-5191 CONTACT NAME: PHONE $77 945-7376 FAX (888) 467-2378 IC No E.0:(877) AIQNo: AID, EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAICN INSURERA:XL Specialty Insurance Company 37885 INSURED INSURER B INSURER C Special Service for Groups INSURER D 605 W. Olympic Blvd., Suite 600 Los Angeles, CA 90015 INSURER E NSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOROTHER DOCUMENTWITH RESPECTTO 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 ADULSUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSRIWVD POLICY NUMBER MMIODIYYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea rre occunce $ CLAIMS-MADE1:1 OCCUR MED EXP (Any one person) $ PERSONAL& ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ POLICY PRO LOC_ _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ _ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURYPeraccidere $ AUTOS AUTOS ( ) HIRED AUTOS NON -OWNED PROPERTY DAMAGE $ AUTOS PERACCIDENT UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION$____ ___ $ WORKERS COMPENSATION X WC ST TU- OTH - ANDEMPLOYERS'LIABILITV YIN TORY LIMITS, ER A ANY PROPRIETOR/PARTNERIEXECUTIVE� N/A RWD500028502 10/1/2013 1011/2014 EL. EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? — ---- (Mandatory In NH) ET. DISEASE - EA EMPLOYEE__$ 1,000,000 If yas, describe under _ DESCRIPTION OF OPERATIONS be ow E L. DISEASE, POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If more space Is required) _ THIS CERTIFICATE VOIDS AND REPLACES PREVIOUSLY ISSUED CERTIFICATE DATED 9/27/2013. r+ IX „i,T..1l,_f`•.,Ij'(1 pyOV A% )/L15A E. S t C FSGK CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana, its officers, employees, agents, volunteers, and representatives AUTHORIZED REPRESENTATIVE Santa Ana Workforce Investment Board &r} /l 1000 E. Santa Ana Blvd., Suite 200 –'�- ISanta Ana CA 92701 —__- © 1988-2010 ACOR ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD EXI-111BIT I CORPORATION. All rights reserved.