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AC O CERTIFICATE OF LIABILITY INSURANCE �'� DATE20 6 VYYY) 12/27/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES - LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED ( RESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer ri hts to the certificate holder in lieu of such andorsemends). PRODUCER Arthur J. Gallagher 3t Co, 9 Insurance Brokers of California, Inc. LIC# 0726293 1255 Battery Street #450 San Francisco CA94111 CONTACT NAME: _ PHONE FAX AaNP Fall --_, Arc unt 9 -MAL INSURER(S) AFFORDING COVERAGE MAIC# INSURERA:NonPrOfits' United Workers' Compens MED EXP (An ane person) E _ INSURED NONPUNI-01 Orange County Conservation Corps. 1853 N. Raymond Avenue Anaheim, CA 92801 INSURER B:Safety National CasualtyCorporatio 15105 INSURER C: INSURER D: INSURER E, INSURER F: OtJVtRAGES CERTIFICATE NIIMRFR- 1943319935 octncrnm All rano el . THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF POLICY EFF POLICY EXP LTR ISD WVD POLICY NUMBER MNVDDNYYY MM/DONYYY LIMITS Santa Ana CA 92701 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [::] OCCUR _._. AUTHORIZED REPRESENTATIVE USA EACH OCCURRENCE E — PREMISES Ea occurrence $ MED EXP (An ane person) E .&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER; POLICY [71 PR0JECj ❑ LOC _PERSONAL GENERAL AGGREGATE E PRODUCTS - COMP/OP AGG E OTHER: E AUTOMOBILE LIABILITY 5 ANY AUTO - INJURY person) S OWNED SCHEDULED AUTOS ONLY AUTOS INJURY accident) E HIRED NON -OWNED AUTOS ONLY AUTOS ONLY G�UMBRELLA 7AGGREGATE LIABLJ OCCUR RRENCE 5 EXCESS LIAB CLAIMS -MADE $ DED RETENTIONE $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNEWEXECUTIVE ❑NIA OFFICERJMEMBER EXCW DEDP NPU - WCG 001-2017 1/12017 1/1/2010 X I PEROTH- STATUTE ER L E.L. EACH ACCIDENT 5500,000 E,DISEASE - EA EMPLOYE 5500,000 (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below __ ._._.____ _ E.L. DISEASE -POLICY LIMIT 5500,000 B Excess Wokers' Comp SP 4056129 1/1/2017 "BLImIter Occurence Statutoryer Occ & Agg 2,000,000500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, my ba attached U sere space Is requiredl u CtK I MCA I t HULUtR r.ANf:FI I ATInIV Santa Ana Workforce Investment Board 1000 East Santa Ana Boulevard #200 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana CA 92701 _._. AUTHORIZED REPRESENTATIVE USA K) 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD