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DiglW ly signed by Francine e. <br />Francine R. Villareal Vlllvreei <br />1 , ® <br />ACCM CERTIFICATE OF LIABILITY INSURANCE <br />�"-� <br />ua,e: mn.aa 1415:50:43 07.0 <br />DATE (MM/DDNYYY) <br />3/26/2021 <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 pollcy(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 Iieu of such endorsement(s). <br />PRODUCER <br />(OC) Heffernan Insurance Brokers <br />18004 Sky Park Circle, Suite 210 <br />Irvine CA 92614 <br />C TACT <br />PHONE FAX <br />• 949-771-3400 c No, 949-771-3401 <br />E-MAIL <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURERA: Philadelphia Indemnity Insurance Company <br />18058 <br />Lice seM 0564249 <br />INSURED ORANCOU-05 <br />Orange County's United Way <br />18012 Mitchell South <br />INSURER B : <br />INSURER C: <br />INSURER D : <br />Irvine CA 92614-6008 <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 556839919 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 />SUER <br />POLICY NUMBER <br />POLICYEFF <br />MMIDDIYYYYI <br />POLICY EXP <br />IMM)mNYYYY1 <br />LIMITS <br />A <br />X <br />COMMERCIALGENERAL LIABILITY <br />CLAIMS-MADErx] OCCUR <br />Y <br />PHPK2202136 <br />11/1/2020 <br />11/1/2021 <br />EACH OCCURRENCE <br />$1,000,000 <br />DA ETO RENTED <br />PREMISES Ea occurrence <br />$1,000,000 <br />MED EXP (Any one parson) <br />$20,000 <br />PERSONAL S ADV INJURY <br />$1,000,000 <br />GEN'L <br />X <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY D PRO- <br />JECT ❑OC <br />GENERAL AGGREGATE <br />$2,000,000 <br />PRODUCTS - COMP/OP AGO <br />$2,000,000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />PHPK2202136 <br />11/1/2020 <br />11/1/2021 <br />EOMaBIINdEeDISINGLELIMIT <br />$1,000,000 <br />ANYAUTO <br />BODILY INJURY (Per parson) <br />$ <br />I$ <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY(PeracddenQ <br />$ <br />X <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTYDAMAGE <br />Per amident <br />A <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />PHUB744991 <br />11/1/2020 <br />11/1/2021 <br />EACH OCCURRENCE <br />$5,000,000 <br />AGGREGATE <br />$5,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I X I RETENTION$ i <br />$ <br />WORKERS COMPENSATION <br />PER OTH- <br />AND EMPLOYERS' LIABILITY YIN <br />ANYPROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBEREXCLUDED? <br />N/A <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE-EA EMPLOYEE <br />$ <br />(Mandatory in NH) . <br />I(yes, descdhe under <br />DEL.I.RIPTION OF OPERATIONS hel <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Re: CARES for Tenants Program (ERAP Funds). City of Santa Ana, officers, agents, employees, representative and volunteers are included as an additional <br />insured (primary and non-contributory) on General Liability policy per the attached endorsements, if required. Cancellation notice endorsement on the General <br />Liability policy is attached. This Certificate replaces and supersedes all previously Issued certificates. <br />I19LNAl:111:to] III a]q:4 <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, 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 <br />©1988.2015 <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />40 aaft RMkManagemeatkOPde4mr <br />3 , gRREAEWED&gAPPRIO/VtE)� B�Y�/: <br />8 `, 7 r'4M -6H 6w �+uAR1tALC <br />Rak Management Analyst <br />