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AC"Ra CERTIFICATE OF LIABILITY INSURANCE F DATE (MMtDDIYYYYI <br />1 12118/2014 <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 />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 />PRODUCER <br />Arthur J. Gallagher & Co. <br />Insurance Brokers of California, Inc. LIC# 0726293 <br />1255 Battery Street #450 <br />San Francisco CA 94111 <br />INSURED NONPUNI-01 <br />Orange County Conservation Corps. <br />1853 N. Raymond Avenue <br />Anaheim, CA 92801 <br />FAX <br />.......... <br />INSURER(S) AFFORDING COVERAGE <br />.. <br />INSURER A: Safety National Casualty Co ratio <br />. . . . .. ........... . . . .. .... . ...... Y..­T� <br />INSURER B: Non " P - rofits' United Worker , s' , Compen - s <br />INSURER C: <br />INSURER 0: <br />INSURER E: <br />rnvFPanFR rFRTIIi:IrATF mtjmRFP- 2040920319 PFVI.qIt1N1 N1111VIRPRI <br />15105 <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 />— - I 'SUBR <br />MR ADDLI --_---------- ------ - -- --- P6Cf6Y_EFF­_ POLICY .- Y .- EXP . . . . .. ..... . .. <br />I <br />POLICY NUMBER LIMITS <br />LTR TYPE OF INSURANCE INSO I WVD I 1MMfDDIYYYY) I (MMIDDJYYYY�' <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />I <br />CLAIMS -MADE OCCUR <br />DAMAGE TO RENTED <br />PREMISES CELoccurrence ) <br />MED EXP (Any one person) <br />PERSONAL& ADV INJURY <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />. ... ... . ..... .... .. . . <br />PRO - <br />POLICY J ECT LOC <br />PRODUCTS - COMP/Op AGG <br />. <br />. .. .......... . .... ............... ........ <br />OTHER: <br />AUTOMOBILE LIABILITY <br />ANY AUTOBODILY <br />'01MINNEDSINGLEU T_ <br />FT.' qen . . ........ . . <br />INJURY (Per person) <br />$ <br />ALL OWNED SCHEDULED <br />AUTOS IAUTOS <br />BODILY INJURY (Per accident <br />) <br />.. .. .... ... . . ........ . ...... .. . .... . .. <br />$ <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />DAMAGE <br />(Par accidertL_., <br />$ <br />UMBRELLA LIAR OCCUR <br />EACH OCCURRENCE <br />EXCESS LABAGGREGATE <br />CLAI:MS-MADE <br />$ <br />DIED RETENTION $ <br />WORKERS COMPENSATION <br />NPU - WCG 001 -2015 )N/2015 <br />1/1/2016IPFAR7UIE X OTH- <br />ER <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />_ST <br />E.L. EACH ACCIDENT <br />$500,000 <br />OFFICrRiMEMBER EXCLUDED? D <br />NfAl <br />$500,000 <br />(Mandatory in NH) <br />F.L. DISEASE - FA EMPLOYE I� <br />If yes, desce under <br />ft <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY 1 <br />$5()0,000 <br />A 'Excess Wokers'Comp <br />I <br />SP 4052095 111/2015 <br />1/1/2016 ,Limit Per Occurence Statutory <br />I E, L, Per Occ & Agg 2,000,000 <br />;Xs of 500,000 <br />I I <br />DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />5K,ry <br />99 <br />L;LK I It- IL;A I t HUL[JtK L;ANUtLLA I IUN <br />I I <br />City of Santa Ana <br />20 Civic Center Plaza <br />Santa Ana CA 92701 USA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />REPRESENTATIVE <br />071588-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />