COMMUNITY HEALTH INITIATIVE OF ORANGE COUNTY

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Digitally signed by Francine R. Francine R. Villareal Villareal Date: 2021.03.08 13:55:50-08'00' A� " CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 02125/2021 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 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Certificate Issuance Team NAME: Comprehensive Insurance Services HCNE. (949) 709-8800 a/c, (949) 709-1668 Ext : No): 26429 Rancho Parkway South E-MAIL jeremy@thecomprehensiveinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Suite 120 INSURERA: Nonprofits Insurance Alliance of California 10023 Lake Forest CA 92630 INSURED INSURER B Community Health Initiative of Orange County INSURER C : 1505 E. 17th Street, Suite 121 INSURER D : INSURER E : Santa Ana CA 92705 INSURER F : COVERAGES CERTIFICATE NUMBER: CL2082704831 REVISION NUMBER: THIS IS 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 LTR TYPE OF INSURANCEAUULbUBK INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FX OCCUR PREM SDA AGES Ea oNcurDmnce $ 500,000 MED EXP (Any one person) $ 20,000 PERSONAL &ADV INJURY $ 1,000,000 A Y 2020-44927 10/15/2020 10/15/2021 LAGGREGATE LIMITAPPLIES PERGENERAL AGGREGATE $ 2,000,000 POLICY ElPRO FX LOC JECT: MOTHER PRODUCTS-COMP/OP AGG $ 2,000,000 $0 Deductible $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS 2020-44927 10/15/2020 10/15/2021 BODILY INJURY (Per accide nt) $ X PROPERTY DAMAGE Per accident $ HIRED �/ NON -OWNED AUTOS ONLY X AUTOS ONLY $0 Deductible $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ElN OFFICER/MEMBER EXCLUDED? /A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Social Service Professional $1,000,000/1,000,000 Aggregate/Occ A Improper Sexual Conduct 2020-44927 10/15/2020 10/15/2021 $1,000,000/1,000,000 Aggregate/Occ $0 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana, officers, agents, employees, and volunteers are included as additionally insured on this policy pursuant to written contract or written agreement per attached endorsement NIAC E61. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City shall be excess and noncontributory per attached endorsement NIAC E61. 30 day notice of cancellation with 10 day notice of cancellation for non-payment of premium per policy provision. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana ACORD 25 (2016/03) CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2015 The ACORD name and logo are registered marks of ACORD µow NCF Risk ManagementDivisian k4e 1'x REVIEWED & APPROVED BY.- .v —� Risk hrtanagement Analyst