Laserfiche WebLink
Francine R. Digitally signed by Francine R. <br />Villareal <br />Villareal <br />Date:2021.10.0716:1435-07'00 <br />A`� o CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <br />09/27/2021 <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 Certificate Issuance Team <br />NAME: <br />Comprehensive Insurance Services <br />A/CONN. Ext : (949) 709-8800 q/c, No): (949) 709-1668 <br />E-MAIL jeremy@thecomprehensiveinsurance.com <br />ADDRESS: <br />26429 Rancho Parkway South <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />Suite 120 <br />Lake Forest CA 92630 <br />INSURERA: Nonprofits Insurance Alliance of California <br />10023 <br />INSURED <br />INSURER B <br />Community Health Initiative of Orange County <br />INSURER C <br />1505 E. 17th Street, Suite 121 <br />INSURER D <br />INSURER E : <br />Santa Ana CA 92705 <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: CL2192705434 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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 />INSD <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DDIYYYY <br />POLICY EXP <br />MM/DDIYYYY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE OCCUR <br />DAMAGE TO RENTED <br />SES Ea occurrence) <br />PREMISES <br />$ 500,000 <br />MED EXP (Any one person) <br />$ 20,000 <br />PERSONAL &ADV INJURY <br />$ 1,000,000 <br />A <br />Y <br />2021-44927 <br />10/15/2021 <br />10/15/2022 <br />LAGGREGATE LIMITAPPLIES PERGENERAL <br />AGGREGATE <br />$ 2,000,000 <br />POLICY ❑ PRO FXLOC <br />JECT: <br />MOTHER <br />PRODUCTS-COMP/OPAGG <br />$ 2,000,000 <br />$0 Deductible <br />$ <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 />2021-44927 <br />10/15/2021 <br />10/15/2022 <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 />$0 Deductible <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LAB <br />CLAIMS -MADE <br />DED I I RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />PER OTH- <br />STATUTE ER <br />ANY PROPRIETOR/PARTNER/EXECUTIVE El <br />OFFICER/MEMBER EXCLUDED? <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />A <br />Social Service Professional Liability Improper Sexual Conduct Liability <br />2021-44927 <br />10/15/2021 <br />10/15/2022 <br />$1,000,000/1,000,000 <br />$1,000,000/1,000,000 <br />Aggregate/Occ <br />Aggregate/Occ <br />$0 Deductible <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />City of Santa Ana, officers, agents, employees, and volunteers are included as additionally insured on this policy pursuant to written contract or written <br />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 <br />excess and noncontributory per attached endorsement NIAC E61. 30 day notice of cancellation with 10 day notice of cancellation for non-payment of <br />premium per policy provision. <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana <br />ACORD 25 (2016/03) <br />CA 92702 <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 PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />©1988-2015 AC <br />The ACORD name and logo are registered marks of ACORD <br />�oRaN IiiskManagmerdDivisian <br />REVIEWED & APPROVED BY. - <br />Risk Management Analyst <br />