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HUMAOPT-04 — __.._H B C11 61
<br />DATE: (MM"DUiYYYYI,
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />1 091281/2017
<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 hol d er is an ADDITIONAL IN
<br />SURED, the clic les 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 />I this — certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />License# 0564249 CONTACT
<br />PRODUCER
<br />NAMPA
<br />Heffernan Insurance Brokers PHONE, -3400 FAX -3401
<br />18004 Sky Park Circle, Suite 210 IAIC, No E�t�: (AIC No):(949) 771
<br />Irvine, CA 92614E MAIL
<br />ASDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAM is
<br />INSURER A:./Nonprofits Insurance Alliance of California 0,1184
<br />INSURED INSURER B: New York Marine & General Insurance Company 16608
<br />Human Options INSURER C
<br />PO Box 53745 INSURER D
<br />Irvine, CA 92519 NSURER E:
<br />�NSURER F
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />TKS 13 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, TERN OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT tiVTH RESPECT TO WHICH THIS
<br />CERTIFICATE [JAY BE ISSUED OR NIAY PERTAIN THP 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 CLAINIS.
<br />INSR TYPE OF INSURANCE VV
<br />ADDL SUER POLICY NUMsER POLICY EFF POLICY FXP
<br />LTR TINS© VD —.-WM 9WYYYY) WWDOIYYYY'4 LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY EACH, OCCURRENCE
<br />DAMAGE TO RENTED 500,000
<br />GLAHMS-MADE X OCCUR X 201701143NPO 09/2312017 09123/2018 PREM Sys (Ea oc-wrem�)
<br />MED EXP IAny one pe sone 2010001
<br />P-z;,-,SONAL & ADV 114JURY S 11,000,000
<br />GEN1 AGGREGATE LIMIT APPLIES PER (GENERAL AGGREGAI E S 3,000,000
<br />PC
<br />POLICY JFCT X LOC 3,000,060
<br />P170DUCTS - COMP,CP AGC, S
<br />OTHER SEXUAL MISCONDU 1,000 0001
<br />AUTOMOBILE LIABILITYCOMBINED SING -LE LIMiT 1,000,000
<br />.(Ea accidenQ
<br />'NY AUTO 2017011143NPO 0912312017 0912312018 BOCILY NJURY ,Rorpers,nj
<br />0INNEE) SCH=DULFD
<br />AUTOS ONLY A-'Nbs BODILY �N'f aPel accidenl� S
<br />X X NON-CAINED F
<br />,Z,13PERTY DM,1AGE
<br />AUTOS OM.Y AUT08 ONLY S
<br />A X UMBRELLA LIAB X or -CUR EA CH OCCI RRENCE S 5,000,0001
<br />EXCESS LAB CLAINTS-MADE 2131701143UMB 0912312017 0912312018 AGGREGATE 5,000,000
<br />DED X RETEENTONS 10,000
<br />B WORKERS COMPENSATION x PFR ()-k--
<br />AND EMPLOYERS' LIABILITY YiN - STATU TE FR..
<br />ANY PRrPRIEC)P,/P�,RTNERe�-YIEC;UTVE NIA WC201700013809 04/0112017 04101/2018 . E.L. EACH ACCIDENT S 1,000,000
<br />QFFI CERAIPMEER FXCLUDPO'
<br />(Mandatory in NH) 2 L. DISEASE , 12A Ei%,FLGY--E S 1,000,000
<br />if,,as, des cril)e undar
<br />DESCP,IPl *N OF OPEPAT CITS b�low L DiSRASE - POLK',Y LAVT S 1,000,000
<br />...... .... . ......
<br />A Professional Liabili 201701143NPO 09f23/2017 0912312018 Per Claim 11000,000
<br />A Sexual Misconduct 201701143NPO 09/2312017 09123/2018 Occurrence 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Additional Remarks SChadLlle, may be aftached if Rnore space 9s 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. 11
<br />'i'v "r - o
<br />"
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PPOVISIONS.
<br />Community Deveiopment Agency
<br />20 Civic Center Piaza, M-25
<br />Santa Ana, CA 92701 AUTHORIZED REPRE S EN TATNE
<br />ACORD 25 (2016/03) Oc 1938.2015 ACORD CORPORATION, All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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