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HUMAOPT-04
<br />HUYANI
<br />Aii C)MiX
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDD.IYYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />414/2017
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE, H'O'LDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND DR 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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy„ certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement s .
<br />PRODUCER License # 0564249
<br />''..... NAME CT T
<br />Heffernan Insurance Brokers
<br />PHONE
<br />n, Ext): 1 (949) 771-340'0 {AAac„ NeI:(949) 771-3401
<br />18004 Park Circle, Suite 210
<br />Sky
<br />ACD; _._...... _..
<br />Irvine, CA 92514
<br />INSURER(S) AFFORDING COVERAGE MAIC it
<br />INSURER A:Nonprofits Insurance Alliance of California '01184
<br />INSURED
<br />INSURER B: New York Marine & General. Insurance
<br />16608
<br />INSURER C _.._..il
<br />0812312017
<br />Human Options
<br />PO Box 53745
<br />INSURER D:
<br />Irvine„ CA 92619
<br />_.-._.___ w
<br />INSURER E
<br />INSURER F :
<br />_
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 RESPECTTO 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 />INSR
<br />LTRTYPE
<br />OF INSURANCE
<br />ADDL
<br />D
<br />SUBR.
<br />MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />EACH OCCURRENCE
<br />$ 1,.000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADIE X OCCUR
<br />X
<br />2016-01143
<br />09123/2016
<br />0812312017
<br />DAMAGE To RENTED
<br />REMI�iUAU 'puurrence
<br />500,000
<br />$
<br />20,000
<br />_
<br />EErrsnNAL a, Arlo INJURY
<br />$ m 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />�....
<br />$ 3,000,000
<br />POLICY '..LOC
<br />JE °F7X
<br />PRODUCTS - COMPIOP AGO
<br />.^........_. 3,000.,600
<br />S
<br />OTHER:
<br />SEXUAL MISCOND'U
<br />1,000',000
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMEINED SINGLE LIMIT
<br />Ea accidentS
<br />1,000',000
<br />....._
<br />BODILY INJURY (Perp
<br />5
<br />ANY AUTO
<br />2016-01143
<br />09123/2015
<br />0912312017
<br />OWNED SCHEDULED...
<br />I
<br />AUTOS ONLY AUTOS
<br />BODILYINJIJRY_IPeraccident
<br />S
<br />)(
<br />HIRED X NON -OWNED
<br />PROPERTY DAMAGE.
<br />AUTOS ONLY __,...., AUTOS ONLY
<br />Per accrdenk),,........_
<br />S
<br />S
<br />A.
<br />X
<br />UMBRELLA LIIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />2016-01143-UMB
<br />09/23/2016
<br />09/2312017
<br />AGGREGATE
<br />5,000,000
<br />$_.....,._.....
<br />DED i X RETENTION'. $ 10,000
<br />V
<br />S
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />X PER OTH-
<br />STATUTE ER
<br />E.. L. EACH ACCIDENT
<br />1,000,000
<br />YIN
<br />ANYPROPRIETORIPXCLUDYdEXECtJTIVE ❑
<br />ERYMEMBER EXCLUDED?
<br />N d A
<br />WWC201700013809
<br />0410112017
<br />0410112018
<br />_..
<br />E.L. DISEASE - EA EMPLOYEE
<br />1,000,000
<br />$
<br />(Miu,
<br />(Mandatory In NNI
<br />If Yes, describe under
<br />1,000,000
<br />DESCRIPTIONS. SOF OPERATIONS below
<br />E,. L. DISEASE - POLICY LIMIT
<br />$
<br />A
<br />,Professional Liab.
<br />2016.01143
<br />6512.312016
<br />09123/2017
<br />Occurrance
<br />1,000,000
<br />A
<br />(Sexual Misconduct
<br />2016-01143
<br />0'912312016
<br />09/2312017
<br />Occurrence
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS l VEHICLES (ACORD 141, Addlitlunal Remarks Schedule, may be attachedif more space is required)
<br />Re: As per Contract or Agreement on file with Insured. The City of Santa Ana, its officers, employees, agents and volunteers and representatives are included
<br />as an additional insured (and primary) on General Liability policy per the attachedendorsement, if required.
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2016103) @ 1988-20'15 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City
<br />Cit of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Community Development Agency
<br />20 Civic Center Plaza, M-25
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92..701
<br />ACORD 25 (2016103) @ 1988-20'15 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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