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WUMCN-3 UN lU: I H
<br />Lam'
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDIYYYYI
<br />09/0712016
<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 endorsement(s).
<br />PRODUCER
<br />Fullerton Insurance Service
<br />CDI #0596796
<br />CONTACT
<br />NAME; Commercial Lines Dept.
<br />PNONE 714-577-5$00 FPi7C
<br />o Ext : Arc m.)j 714-447-0011
<br />ADORIEss: reC fullertoninsurance.com
<br />P,O.Box 4054
<br />Fullerton, CA 92834-4054
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 7V-7 OCCUR
<br />Leslie A. McCarthy, CIC
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURER A: New York Marine & General Ins. 16608
<br />09/0112016
<br />INSURED Women's Transitional Living
<br />INSURER B: Nonprofits Ins. Alliance of CA
<br />Center Inc.
<br />TO RENTED
<br />PREMISES Ea occurrence $ 500,000
<br />P.O. Box 916
<br />INSURER C :
<br />INSURER D:
<br />Fullerton, CA 92832
<br />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 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 />IPOLICY
<br />LTR
<br />TYPE OF INSURANCE
<br />AND
<br />WVD
<br />POLICY NUMBER
<br />EFF
<br />MM DDIIYYYY
<br />POLICY EXP
<br />MM DDIYYYY
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 7V-7 OCCUR
<br />X
<br />201601835NPO
<br />09/0112016
<br />09/01/2017E
<br />EACH OCCURRENCE $ 1,000,000
<br />TO RENTED
<br />PREMISES Ea occurrence $ 500,000
<br />MED EXP (Any one person)) $ 20,000
<br />PERSONAL &ACV INJURY $ 1,000,000
<br />GEN'L
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />PRO -
<br />POLICY 71 JECTPRC ❑ LOC
<br />GENERAL AGGREGATE $ 2,000,000
<br />PRODUCTS-COMPlOP AGG $ 2,000,000
<br />Emp Ben. $ 1,000,000
<br />OTHER:
<br />I
<br />AUTOMOBILE
<br />LIABILITY
<br />Ea aBI EDtSINGLE LIMIT $ 1,000,000
<br />B
<br />X
<br />ANY AUTO
<br />201601835NPO
<br />09/0112016
<br />09/01/2017
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident) $
<br />X
<br />HIRED AUTOS X qNO�INp-OgWNED
<br />PROPERTYDAMAGE
<br />$
<br />X
<br />$10bO CGLL
<br />$500 COMP X
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 5,000,000
<br />AGGREGATE $ 510001000
<br />B
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />201601835UMBNPO
<br />09/0112016
<br />09/01/2017
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE Y r N
<br />OFFICER/MEMBER EXCLUDED? ®
<br />(Mandatory in NH)
<br />If yes, desoribe under
<br />DESCRIPTION OF OPERATIONS below
<br />N / A
<br />WC201700005441
<br />03/28/2017
<br />03/28/2018
<br />X STATUTE �R H
<br />AND
<br />E,L, EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,00
<br />B
<br />Sexual Conduct
<br />20160183SNPO
<br />09/01/2016
<br />09/01/2017
<br />Aggregate 1,000,000
<br />Deductible
<br />$0
<br />Ea. Claim 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />City of Santa Ana, its officers, agents employees and volunteers are named
<br />as additional insureds as respects to the general liability policy limits
<br />per endorsement CG2012 attached to the policy with coverage primary and
<br />non-contributory per endorsement NIAGE61 attached to the policy.
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />CITYSI 0
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cit of Santa AnaIESG
<br />Y
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Daniel Perez
<br />PO Box 1988, M-25
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2014101)
<br />©1988-2014 ACORD CORPORATION, All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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