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Digitally signed by Francine R.
<br />Francine R. Villareal Villareal
<br />A� " CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY) 0
<br />DATE DN
<br />022
<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 />Arthur J. Gallagher & Co.
<br />Insurance Brokers of CA., Inc.
<br />505 N Brand Blvd, Suite 600
<br />CONTACT
<br />NAME: Brenda Aldape
<br />PHONE FAX
<br />A/C No Ext : 818-539-8602 A/C, No : 818-539-8702
<br />ADDE-MRESS: Brenda_Aldape@ajg.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />Glendale CA 91203
<br />INSURERA: Philadelphia Indemnity Insurance Company
<br />18058
<br />License#:0726293
<br />INSURED GIRLINC-04
<br />INSURER B :
<br />Girls Incorporated of Orange County
<br />1801 E. Edinger Ave., Ste. 255A
<br />INSURERC:
<br />INSURERD:
<br />Santa Ana, CA 92705
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 1999832514 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 />POLICYNUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />PHPK2127613
<br />6/21/2021
<br />6/21/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ 20,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />POLICY ❑PRO ❑
<br />JECT LOC
<br />X
<br />PRODUCTS - COMP/OP AGG
<br />$ 3,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />PHPK2127613
<br />6/21/2021
<br />6/21/2022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<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 />UMBRELLALIAB
<br />X
<br />OCCUR
<br />PHUB720605
<br />6/21/2021
<br />6/21/2022
<br />EACH OCCURRENCE
<br />$3,000,000
<br />AGGREGATE
<br />$ 3,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ 1 n nnn
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />PER OTH-
<br />STATUTE ER
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />N/A
<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 />Abuse or Molestation
<br />PHPK2127613
<br />6/21/2021
<br />6/21/2022
<br />Per Claim
<br />$1,000,000
<br />Aggregate
<br />$3,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Policy: Professional Liability
<br />Policy Term: 6/21/2021 to 6/21/2022
<br />Policy #: PHPK2127613
<br />Carrier: Philadelphia Indemnity Insurance Company
<br />Each Claim: $1,000,000 Aggregate: $3,000,000
<br />City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or
<br />See Attached...
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL
<br />BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702
<br />AUTHORIZED REP ESENTATIVE
<br />@ 1988-2015 ACORD Cl�,
<br />u" aycF
<br />-
<br />ILLi3R M&T7Agt'.Ih12t'lt DlVl8l01t
<br />REVIEWED & APPROVED BY.-
<br />ACORD 25 (2016103)
<br />The ACORD name and logo are registered marks of ACORD
<br />_ _—
<br />Wsk Management Analyst
<br />
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