|
DATE (MM/DD/YYYY)
<br />AC"R" CERTIFICATE OF LIABILITY INSURANCE F05/17/2024
<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(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 ckes not confer rights lip the certificate holder in lieu of such mdo Ap t Q 114'
<br />PRODUCER :ONT T
<br />A M E:
<br />Newfront InsuraAn
<br />s I f - ONE (650) 412-7542 FAX (650) 488-8566
<br />C No xt : A/C, No):
<br />777 Mariners Isl E TAIL
<br />nae@Ae eon
<br />/_ AI
<br />Suite 250 INSURER(S) AFFORDING COVERAGE NAIC #
<br />San Mateo CA 94404 N rofits' I r li ce
<br />INSUR
<br />INSURED IN�i,. �"Ip 35076
<br />-1
<br />A No a an S iti n ter, cO INSURER C : U. derwnca.s at Lloyd's, London 0000
<br />INSURER E :
<br />Santa Ana CA 92701 I INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: CL2451761282 REVISION NUMBER:
<br />THIS IS TO CERTIFYTHAT 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 ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />UBR
<br />WVD
<br />POLICY NUMBER
<br />MM/DD YYYYMPOLICY EFF
<br />ICY EXP
<br />O DD YYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />� OCCUR
<br />DAMAGE
<br />PREM SESOEa occu«Dence
<br />$ 500,000
<br />_7CLAIMS-MADE
<br />MED EXP (Any one person)
<br />$ 20,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />Y
<br />2024-01391
<br />06/05/2024
<br />06/05/2025
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />X POLICY ❑ PRO ❑
<br />JECT LOC
<br />PRODUCTS - COMP/OPAGG
<br />3,000,000
<br />$
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />2024-01391
<br />06/05/2024
<br />06/05/2025
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED �/ NON -OWNED
<br />AUTOS ONLY X AUTOS ONLY
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I I RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />(Mandatory in NH)
<br />NIA
<br />Y
<br />9100741-23
<br />10/01/2023
<br />10/01/2024
<br />X SPER
<br />TATUTE EORH
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE- EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE- POLICY LIMIT
<br />1,000,000
<br />$
<br />C
<br />Cyber Liability
<br />ESM0139762497
<br />09/01/2023
<br />09/01/2024
<br />Limit of liability
<br />Deductible
<br />$1,000,000
<br />$2,500
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Insr Ltr:A: Sexual Conduct Liability coverage ; Policy #2024-01391; Policy Eff. dates: 06/05/2024-06/05/2025; Limit: Each Claim: $1,000,000; Aggregate:
<br />$1,000,000
<br />Insr Ltr:A: Social Services Professional Liability; Policy #2024-01391; Policy Eff. dates: 06/05/2024-06/05/2025; Each Event: $1,000,000; Each Aggregate:
<br />$2,000,000
<br />City of Santa Ana is included as additional insured on General liability policy per the attached form. General liability coverage is primary and non-contributory
<br />per the attached form. Waiver of Subrogation applies to General Liability and Worker's Compensation policies per the attached forms
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana,
<br />CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PRO)
<br />AUTHORIZED REPRESENTATIVE
<br />Risk Management Diyisian
<br />�?- REVIEWED & APPROVED BY:
<br />A AeCV 4
<br />® Risk Management Specialist
<br />© 1988-2015
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|