|
' Francine R. usually Maned by Fandne N.
<br />\/il6rml mllareal
<br />ACORO® CERTIFICATE OF LIABILITY INSURANCE
<br />DAT5 OD YYYY)
<br />05/27/2021
<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 endomement(s).
<br />PRODUCER
<br />CONTACT Certificate Issuance Team
<br />NAME:
<br />Comprehensive Insurance Services
<br />PHONE (949) 709-8800 a0 No : (949) 709-1668
<br />26429 Rancho Parkway South
<br />ADDRESS: Jeremy@thecomprehensiveinsurance.com
<br />Suite 120
<br />INSURERS AFFORDING COVERAGE
<br />NAIG9
<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 />NSURER E:
<br />Santa Ana CA 92706
<br />1 INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: ULZU112304954 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 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 />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />IMM/DDIYYVY
<br />MM/DD/YYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LWBILITY
<br />CLAIMS -MADE ®OCCUR
<br />OCCURRENCE
<br />$ 11000,000
<br />ISESEaoccurrece
<br />$500,000
<br />XP An one arson
<br />20,000
<br />NAL BADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />2120-01211
<br />12/21/2020
<br />12/21/2021
<br />GEHL AGGREGATE LIMITAPPLIES PER:
<br />POLICY ECOT 1E LOC
<br />ALAGGREGATE
<br />$ 2,000,000
<br />UCTS -COMP/OPAGG
<br />RCOWINEDSINGLE
<br />$ 2,000,000
<br />eductible
<br />$
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />I EDSINGLE LIMIT
<br />older,ANY
<br />$ 1,000,000
<br />Y IWURY(Perperson)
<br />$
<br />AUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />2020-09201
<br />12/21/2020
<br />12/21/2021
<br />Y INJURY(Per accident)
<br />$
<br />HIRED v NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />ERTY DAMAG
<br />citlenteductible
<br />$
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMSMADE
<br />DIED
<br />I I RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N/A
<br />9255171-2021
<br />O6/15/2021
<br />O6/15/2022
<br />PER OTH-
<br />x STATUTE ER
<br />$O Deductible
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,D00
<br />ryes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<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 / 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 carved 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 />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92702 u. _^1-, RieltMDMwgeNlmf1hrislan
<br />-0 :.. _ w.� REvlew 6 APPROVED BY:
<br />©1988-2015ACOR 1 _ �4+crr.L*i �.�ti((.t,tieA(
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Risk Monage,ment Analyst
<br />
|