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HUMAOPT-04 ROOCAI
<br />'41 i CERTIFICATE OF LIABILITY INSURANCE
<br />DA )
<br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO
<br />612912016
<br />THIS CERTIFICATE IS ISSUED ASA 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 INSUREIIi 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 endorsements .
<br />PRODUCER License # 0564249 CONTACT
<br />NAME:
<br />_
<br />Heffernan Insurance Brokers PHONE 1 714 361-7700 x t77t�f FAX 1 714 361-7701
<br />Alc No EX+:i)....... tare, Net: {
<br />6 Hutton Centra Drive, Suite 600 .__
<br />Santa Ana, CA 92707 nooREss:
<br />INSURERS AFFORDING COVERAGE NAIC A
<br />INSURER A;Nonprofits Insurance Alliance of California 01184
<br />INSURED INSURER B: Berkshire Hathaway Homestate Insurance Company 20044
<br />Human Options INSURER C;
<br />PO Box 53745 INSURER D:
<br />Irvine, CA 92619 INSURER E:
<br />INSURER F
<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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO
<br />ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />20 Civic Center Plaza, M-25
<br />INSft TYPE OF INSURANCE ADO R POLICY EFF ROL CY EXP
<br />LTR n O ri POLICY NUMBER MWDDNYYY MM1DDtYYYY LIMITS
<br />A GENERAL LIAE(UTY EACH OCCURRENCE
<br />$ 1,000,00
<br />CLAIMS -MADE [X] OCCUR X 201601143NPO 0912312015 0912312015 PREMISES Ea oecurrenae
<br />$, 500,00
<br />TXCOMMERCIAL
<br />MED EXP (Anyone person)
<br />S 20,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE
<br />$ 3,000,000
<br />POLICYF_] JECT ® LOC PRODUCTS - COMP/OP AGO
<br />if 3,000,000
<br />OTHER I SEXUAL MISCONDU
<br />$ 1,000,000
<br />m
<br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />A ANY AU rC 201601143NPO 09/23/2016 09/23/2016 BODILY INJURY(Perpalaw)
<br />$
<br />ALL OWNED SCHEDULED BODILY INJURy(Peracci....
<br />$
<br />AUTOS AUTOS
<br />X X NON -OWNED PROPERTY DAMAGE
<br />$
<br />NIREU AUTOS AUTOS Per accident
<br />)( UMBRELLALIAB X OCCUR EACH OCCURRENCE
<br />$ 6,000:00
<br />A EXCESS LWe CLAIMS -MADE 201501143UMBNPO 0912312016 0912312016 AGGREGATE
<br />, 6,000,00
<br />OED X RETENTIONS 10,000
<br />g
<br />WORKERS COMPENSATION )( STATUTE figµ_
<br />AND EMPLOYERS' LIABILITY YIN
<br />,,,,
<br />B ANY PROPRIETORIPARTNERIEXECUTIVE HUWC703947 04/0112016 04/0112017 E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED?
<br />1,000,000
<br />(Mandatory In NH) E. L. DISEASE - EA EMPLOYEE
<br />$
<br />ryes, describe under
<br />DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A Professional Llabi6 201501143NPO 09/23/201509/23/2016 Occurrence
<br />1,0003000
<br />A Sexual Misconduct 201501143NPO 09/23/2015 09123/2016 Occurrence
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more apses 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 attached endorsement, if required
<br />I
<br />/{-
<br />t 14—
<br />CERTIFICATE HOLDER CANCELLATION
<br />O 1950-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD
<br />016L
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cit of Santa Ana
<br />Y
<br />Community Development Agency
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />BE DELIVERED IN
<br />20 Civic Center Plaza, M-25
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701
<br />tG
<br />O 1950-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD
<br />016L
<br />
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