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ORANCOU-19 VMXHAVERI
<br />ATE (MMIDDIYYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 1 10/312014
<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 />IMPORTANTIf 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 License # 0726293 CONTACT
<br />Arthur J. Gallagher & Co. Insurance Brokers of CA., Inc. PHONE,,,.JFAX (818) 539-2301
<br />505 N Brand BlvdE
<br />, Suite 600 _(AIC_N0 :(818) 539-2300 LAIC, No):
<br />AIL
<br />Glendale, CA 91203 AE-DDMRESS:
<br />INSURED
<br />Orange County Conservation Corps
<br />1853 N. Raymond Ave.
<br />Anaheim, CA 92801
<br />AFFORDING COVERAGE NAIC li
<br />INSURER A: Great American Insurance Company 16691
<br />INSURER B: Great American Insurance Company of NY _12136
<br />INSURER. C:, Nan Profits United
<br />INSURER D: Hanover insurance Company 122292
<br />INSURER E
<br />INSURER F
<br />rr)k1PPA(1P_q rFPTIFIrATF N[IMIAFR- RFVI-RIC)N NLJMRFFZ-
<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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />LTR
<br />DDL
<br />TYPE OF INSURANCE
<br />I I
<br />Us
<br />�LIMITS
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFIF
<br />(MMfDDNYYYI,
<br />POLICY EXP
<br />IMMIDDNYYY)
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE OCCUR
<br />X
<br />PAC5154680
<br />10/01112014
<br />10/0112015
<br />DAMAGE TO RENTED'
<br />PREMISES Ea occurrence)
<br />$ 100,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL&ADV INJURY
<br />.. .. . . ..... . .. . ....... ..... ........... . ..
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />PRO -
<br />POLICY !ECT E LOC
<br />P DUG -001P/OPAGG
<br />$ 31000,000
<br />OTHER:
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />$ 11000,000
<br />(Ea accident)
<br />B
<br />X
<br />�_ANY AUTO
<br />CAP0991249
<br />10/01/2014
<br />1010112015
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNEDSCHEDULED
<br />r
<br />INJURY (Per accident)
<br />$
<br />AUTOSBODILY
<br />AUTOS
<br />X X NON -OWNED
<br />$
<br />HIRED AUTOS AUTOS
<br />_JPer accident)
<br />UMBRELLA LAB CUR
<br />Oc
<br />EACH OCCURRENCE
<br />1,000,000
<br />A
<br />EXCESS, LIAR CLAIMS -MADE
<br />UMB 5603795
<br />1010112014
<br />1010112015
<br />AGGREGATE
<br />DED RETENTION$ 10,000
<br />1,000,000
<br />1,000,000
<br />WORKERS COMPENSATIONI
<br />OT-
<br />X I STATUTE � ERH
<br />I
<br />C
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOPJPARTNERIEXECUTIVE
<br />NPU-WCG 001-2014 1 01101/2014
<br />01/01/2015
<br />E.L. EACH ACCIDENT
<br />, __
<br />$ 1,000,000
<br />OFFICE RIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NJA
<br />E1. OISEA��.LffA�.EMF�qYEE�
<br />$ 1,1000,00,0
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />F.L. DISEASE - POLICY LIMIT
<br />1 $ 1,000',000
<br />D
<br />Directors & Officers
<br />LH3 9817317 01 12128/2013
<br />12128/2014
<br />Each Claim 2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The City of Santa Ana, its officers, agents, employees and volunteers, and the State of California, its officers, employees, and volunteers are narned additional
<br />insured/Funding Source with respect to the operations of the named insured per the attached CG 2,026 endorsement. Such insurance is Primary and
<br />Non -Contributory. Workers Compensation coverage excluded, evidence only.
<br />r'F=PTIP:1r`.ATP WrIll nF=P r`ANI('F1 I ATIC)NI
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana, Workforce Investment Board
<br />1000 E. Santa Ana Blvd., Ste, 200
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701'
<br />AUTHORIZED REPRESENTATIVE
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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