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Francine R. D1g1 Vilia,esignedbFrancineR.
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<br />lareal 08,00, Z�LK WISECAC-CV'�IALERT
<br />ACORL7µ' CERTIFICATE OF LIABILITY INSURANCE
<br />`.�•-''
<br />WTE(MM/DD/YYYY)
<br />12/29/2021
<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 does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (626) 799-7000 (A/C, No):(626) 441-3233
<br />Bolton Insurance Services LLC
<br />3475 E. Foothill Boulevard
<br />Suite 100
<br />Pasadena, CA 91107
<br />ABDRIESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Tokio Marine Specialty Insurance Company
<br />23850
<br />INSURED
<br />INSURER B : American Healthcare Indemnity Company
<br />39152
<br />INSURERC: Philadelphia Indemnity Insurance Company
<br />18058
<br />Wiseplace, CA Corp. Wise Silver Center dba:
<br />INSURER D :
<br />1411 N. Broadway
<br />Santa Ana, CA 92706
<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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />PHPK2357925
<br />1/1/2022
<br />1/1/2023
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />100,000
<br />$
<br />MED EXP (Any oneperson)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY ❑ PRO ❑ LOC
<br />JECT
<br />PRODUCTS - COMP/OPAGG
<br />$ 2,000,000
<br />SEXUAL PHYSICAL
<br />$ 1,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />PHPK2357925
<br />1/1/2022
<br />1/1/2023
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />PHUB795905
<br />1/1/2022
<br />1/1/2023
<br />AGGREGATE
<br />$ 1,000,000
<br />DED X RETENTION $ 10,000
<br />Personal & Adv
<br />$ 1,000,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N/A
<br />SATIS0324601
<br />8/15/2021
<br />8/15/2022
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE- EA EMPLOYEE
<br />$ 1,000'OOO
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />A
<br />Professional Liab.
<br />PHPK2357925
<br />1/1/2022
<br />1/1/2023
<br />Occurrence
<br />1,000,000
<br />C
<br />Employee Theft
<br />PHSD1616604
<br />5/5/2021
<br />6/9/2022
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />GL Additional Insured applies per CG20130413 attached, only if required by written contract/agreement.
<br />Primary and Non -Contributory Wording applies per PIGLOO50712 attached.
<br />Notice of Cancellation applies per IL00171198 attached,
<br />Additional Insured(s): Cify of Santa Ana, its officers, employees, agents, volunteers and representatives.
<br />RE: Operations of the named insured.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />ty
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL BE DELIVERED IN
<br />Risk Management Division
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, 4th floor
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />y
<br />M&T7Agt'.Ih12d UlNi8101t
<br />G
<br />& D REVIEWEAPPROVED BY.-
<br />a
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD C
<br />The ACORD name and logo are registered marks of ACORD
<br />�`
<br />Risk Management Analyst
<br />
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