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,.- ORANCOU•19 VMXHAVERI
<br />sa. J 71 CERTIFICATE OF LIABILITY INSURANCE
<br />�-----"-
<br />OAT0/3/2O/YYYY)
<br />10/3/2014
<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(les) 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 endorsoment(s).
<br />PRODUCER License # 0726293
<br />Arthur J. Gallagher & Co. Insurance Brokers of CA., Inc.
<br />505 NBrand Blvd, Suite 600
<br />Glendale, CA 91203
<br />CONTACT
<br />PHONE -- Piix---
<br />14 NasaO.(816) 539.2300 �IAIo, N¢UJ818�.538 2301_
<br />E-MAIL
<br />ADDRESS:
<br />INSURERIS)AFFOROING COVERAGE
<br />NAIC#
<br />_ _
<br />INSURER A: Great American Insurance Company
<br />16691
<br />INSURED
<br />INSURER e: Great American Insurance Compal of NY_
<br />22136
<br />Orange County Conservation Corps
<br />1853 N. Raymond Ave.
<br />INSURERC_NonProfits United
<br />_ cLnlMs-MADE X OCCUR
<br />_INSURER o_Hanover Insurance Company
<br />Anaheim, CA 92801
<br />INSURERS;
<br />10/01/2015
<br />INSURER Fv_—_
<br />$100,000
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 1'O THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE. POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TFIE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />_
<br />INS
<br />TYPE OF INSURANCE
<br />BR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM DD YYV
<br />POID Y Y
<br />IDtl V
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />_ cLnlMs-MADE X OCCUR
<br />X
<br />PAC5164680
<br />10/01/2014
<br />10/01/2015
<br />AGrTORENTED"'"—"
<br />pR9M,,ISE3Lqaoccu1ren0a_
<br />$100,000
<br />MED EXP (An Ona erson)
<br />$ 6,000
<br />_
<br />PERSONAL &ADV INJURY
<br />—_—_
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />POLICYF-] PECT RO- LOC
<br />J
<br />PRODUCTS - COMPIOP AGO
<br />$ 3,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ex accWentl
<br />$ 00,
<br />1,0000
<br />-"__ _
<br />BODILY INJURY(Per person)
<br />_
<br />$
<br />B
<br />X ANY AUTO
<br />CAP0991249
<br />10/01/2014
<br />10/01/2015
<br />ALL OWNED SCHEDULED
<br />X AUTOS US
<br />X NON OWNED
<br />HIRED AUTOS AUTOS
<br />BODILYINJURY(Peraccid¢nl)
<br />$
<br />PROPER 1TDAMAGE
<br />Per eccidEiji,
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACHOCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />UMB 5603795
<br />10/01/2014
<br />10/01/2015
<br />DED X RETENTION$ 10,000
<br />1,000,000
<br />$ 1,000,666
<br />C
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABIUTY
<br />ANY PROPRIETORIPARTNER/EXECUTIVE YIN
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />NIA
<br />NPU-WCG 001.2014
<br />01/01/2014
<br />01/01/2016
<br />PER OTH-
<br />X BTATUTE _....
<br />F.L. EACH ACCIDENT
<br />$ 1_000,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />"_'---"--'-'-
<br />$ 1,000,000
<br />If yy¢s, describe under
<br />1) Ins,OF OPERATIONS bel.
<br />E.L. DISEASE -POLICY LIMIT
<br />---------
<br />$ 1,000,000
<br />D
<br />Directors & Officers
<br />LH3 9817317 01
<br />92/28/2013
<br />12/2612014
<br />Each Claim 2,000,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may by electron It more spate 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 named additional
<br />Insured/Funding Source with respect to the operations of the named Insured per the attached CG 2026 endorsement. Such insurance is Primary and
<br />Non -Contributory. Workers Compensation coverage excluded, evidence only.
<br />�I
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana, Workforce Investment Board THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />1000 E. Santa Ana Blvd., Ste. 200 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701 —,--
<br />AUTHORIZED REPRESENTATIVE
<br />/atw�nao YJ
<br />All rlahts reserved
<br />ACORD 25 (2614101) The ACORD name and logo are registered marks of ACORD
<br />
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