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Francine R.
<br />Villareal
<br />Al o® CERTIFICATE OF LIABILITY INSURANCE
<br />DAM (MMODYvvv)
<br />11/2312020
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 endomement(s).
<br />PRODUCER
<br />CONTACT Certificate Issuance Team
<br />NAME:
<br />Comprehensive Insurance Services
<br />A/CNNo Ext: (949) 709-8800 n/c Ne (949) 709-1668
<br />26429 Rancho Parkway South
<br />E-MAIL jeremy@thecomprehensiveinsurance.com
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC4
<br />Suite 120
<br />INSURERA: Nonprofits Insurance Alliance of California
<br />10023
<br />Lake Forest CA 92630
<br />INSURED
<br />INSURERS: State Compensation Insurance Fund
<br />35076
<br />Orange County Children's Therapeutic Arts Center
<br />INSURERC:
<br />2215 N. Broadway
<br />INSURER D :
<br />INSURER E:
<br />Santa Ana CA 92706
<br />1 INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: CL20112304954 REVISION NUMBER:
<br />THIS IS TO CERTIFY THATTHE 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 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 />ILTR
<br />TYPE OF INSURANCE
<br />INSO
<br />WVO
<br />POLICY NUMBER
<br />POLICYEFF
<br />POLICIYYVY
<br />PMIDDA`XP
<br />MM/DD/EXP
<br />LIMITS
<br />X
<br />COMMERCIALGENERALU BILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />�/
<br />CLAIMSMADE /� DDDDR
<br />A ET RENTED
<br />PREMISES Ea occurzence
<br />$ $00,000
<br />MED EYE (Any one person)
<br />$ 20,000
<br />PERSONAL SADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />2020-09201
<br />12/21/2020
<br />12/21/2021
<br />GENTAGGREGATE UMITAPPLIES PER:
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />POLICY ❑ JECT I LOC
<br />PRODUCTS - COMPIOPAGG
<br />$ 2,000,000
<br />$0 Deductible
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINEOSINGLE LIMIT
<br />ire accident
<br />$ 1.000,000
<br />BODILY I NJURV(Per person)
<br />$
<br />ANYAUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />2020-09201
<br />12/21/2020
<br />12/21/2021
<br />BODILY INJURY(Peraccident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Peraccident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOSONLY AUTOSONLV
<br />$0 Deductible
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED
<br />I I RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />CUTIVE
<br />ANY PROMEMBEREXCL EXCLUDED'
<br />O Mandator, in BER EXCLUDED?
<br />(Mandatoryin NH)
<br />NIA
<br />9255171-2020
<br />06/15/2020
<br />06/15/2021
<br />X PER OTH-
<br />STATUTE ER
<br />$0 Deductible
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE -E4 EMPLOYEE
<br />$ 1,000,000
<br />yes, describe under D
<br />DESCRIPTION OF OPERATIONS below
<br />E.L DISEASE-POLICYLIMIT
<br />$ 1,000,000
<br />A
<br />Social Service Professional Liability
<br />Improper Sexual Conduct Liability
<br />2020-09201
<br />12/21/2020
<br />12/21/2021
<br />$1,000,00011,000,000
<br />$1,000,000/1,000,000
<br />Aggregate/Occurr
<br />Aggregate/Occurr
<br />$0 Deductible
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />The City of Santa Ana, its officers, employees, agents, volunteers, and representatives are included as Additional Insured per attached endorsement
<br />CG2026. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by
<br />this policy is primary and is not additional to or contributing with any other insurance cared by or for the benefit of the additional insureds per attached
<br />endorsement NIAC E61. 30 day notice of cancellation with 10 day notice of cancellation for non-payment of premium per policy provision.
<br />City of Santa Ana, Risk Management
<br />20 Civic Center Plaza
<br />4th FI.
<br />Santa Ana
<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 ACORC
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />Ride Maragernmt Diviswn
<br />A/1, �,drrR�� EVIEWEQ & pAPPRQvSQ BY:
<br />1' rrl.trYrr.0 ram. V.G!✓Va[
<br />Risk Management Analyst
<br />OF
<br />
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