|
Francine R. Digitally signed by Francine R.
<br />Villareal
<br />i 1 ® VIIIaICaI
<br />ACCORD CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DDNY'YY)
<br />10/21/2021
<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 />Bowermaster & Associates
<br />10805 Holder St
<br />350
<br />CONTACT
<br />Christine Smiley
<br />PHONE FAX
<br />A/C No Ext : 714-733-6200 A/C, No):
<br />E-MSte
<br />ADDRESS: csmiley@bowermaster.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />Cypress CA 90630
<br />INSURERA: Philadelphia Insurance Companies
<br />INSURED PROJHOP-01
<br />Project Hope Alliance
<br />1954 Placentia Ave, Suite 202
<br />INSURERB: Property & Casualty Ins Co of Hartford
<br />INSURERC: Lloyd's
<br />INSURER D
<br />Costa Mesa CA 92627
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 1002763310 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 />PHPK2340169
<br />10/21/2021
<br />10/21/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 100,000
<br />VIED EXP (Any one person)
<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-
<br />JECT LOC
<br />❑
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />PHPK2340169
<br />10/21/2021
<br />10/21/2022
<br />COEaMBINED ident SINGLE LIMIT
<br />acc
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<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 />OCCUR
<br />PHUB790025
<br />10/21/2021
<br />10/21/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />AGGREGATE
<br />$
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ 1 n nnn
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />72WECAA4H97
<br />8/1/2021
<br />8/1/2022
<br />X PER OTH-
<br />STATUTEI ER
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Abuse Conduct Liability
<br />PHPK2340169
<br />10/21/2021
<br />10/21/2022
<br />Aggregate
<br />1,000,000
<br />C
<br />Cyber Liability
<br />ESJO029264674
<br />2/26/2021
<br />2/26/2022
<br />Each Abuse Conduct
<br />Cyber Liability/Ded
<br />1,000,000
<br />$1,000,000/$2,500
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />City of Santa Ana, officers, agents, employees, and representatives are Additional Insured as respects to General Liability per attached endorsement form.
<br />City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract,
<br />agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance carried by
<br />City shall be excess and noncontributory.
<br />Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation.
<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 />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana
<br />Risk Manegement Division 4th Floor
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />>��DMsiun
<br />�w cF
<br />�, 9t
<br />REVIEWED & APPROVED BY.-
<br />@1988-2015 ACORD C
<br />``
<br />?
<br />ACORD 25 (2016103) The ACORD name
<br />and logo are registered marks of ACORD
<br />_ _—
<br />Wsk Management Analyst
<br />
|