|
Anqie bbx/AnnIPSA aedarin
<br />/ � ® r Date: 202f11�2,7d*TE,(,MM1DD1YYYY)
<br />A�0 CERTIFICATE OF LIABILITY INSURAR@�Ved016:48:18_110/2021
<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 CONNo Ext : (949) 709-8800 FAX
<br />No): (949) 709-1668
<br />26429 Rancho Parkway South
<br />E-MAIL jeremy@thecomprehensiveinsurance.com
<br />ADDRESS:
<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 : State Compensation Insurance Fund
<br />35076
<br />Orange County Children's Therapeutic Arts Center
<br />INSURER C :
<br />2215 N. Broadway
<br />INSURER D :
<br />INSURER E :
<br />Santa Ana CA 92706
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: All 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 />I
<br />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />MMIDDPOLICY EFF
<br />( IYYW)
<br />POLICY EXP
<br />(MM DDIYYYY)
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />PREMISES Ea occurrence
<br />500,000
<br />$
<br />MED EXP (Any one person)
<br />$ 20,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />2021-09201
<br />12/21/2021
<br />12/21/2022
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />OLICY ❑PRO
<br />JECT: FXLOC
<br />RLTHER
<br />PRODUCTS-COMP/OPAGG
<br />2,000,000
<br />$
<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 />ANY AUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />2021-09201
<br />12/21/2021
<br />12/21/2022
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED �/ NON -OWNED
<br />AUTOS ONLY /� AUTOS ONLY
<br />$0 Deductible
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />9255171-21
<br />06/05/2021
<br />06/05/2022
<br />X STER ATUTE �RH
<br />$0 Deductible
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />A
<br />Social Service Professional Liability
<br />Improper Sexual Conduct Liability
<br />2021-09201
<br />12/21/2021
<br />12/21/2022
<br />$ 1,000,000/1,000,000
<br />$1,000,000/1,000,000
<br />Aggregate/Occurr
<br />Aggregate/Occurr
<br />$0 Deductible
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The City of Santa Ana, its officers, officials, employees, and volunteers are included as Additional Insured per attached endorsement CG2026. With respect
<br />to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and
<br />is not additional to or contributing with any other insurance carried by or for the benefit of The City of Santa Ana, its officers, officials, employees, and
<br />volunteers per attached endorsement NIAC E61. 30 day notice of cancellation with 10 day notice of cancellation for non-payment of premium per policy
<br />provision. See attached forms list.
<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
<br />The ACORD name and logo are registered marks of ACORD
<br />Risk ManagementDiAsian
<br />REVIEWED & APPROVED BY.-
<br />z
<br />�_r- Risk Management Specialist
<br />
|