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�® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDNYYY)
<br />08/05/2021
<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(les) 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 endorsements .
<br />PRODUCER
<br />CONTACT Nora Wolkoff
<br />NAME:
<br />PNONE 323, Extl--805-2918 qIC No
<br />Dickerson Insurance Services an Alera Group Company
<br />1918 Riverside Drive, Los Angeles, CA 90039
<br />EDOAIL , Nora@dickerson-group.com
<br />INSURERISI AFFORDING COVERAGE
<br />NAIC N
<br />License #01029112
<br />INSURERA: Philadelphia Indemnity Insurance Company
<br />21044
<br />INSURED
<br />INSURER B: Technology Insurance Company
<br />42376
<br />INSURER c; Hiscox Insurance Agency
<br />10200
<br />Charitable Ventures of Orange County
<br />INSURER D:
<br />Project Kinship
<br />INSURER E i
<br />1505 E. 17th Street, Suite 101
<br />INSURER F:
<br />Santa Ana, CA 92705
<br />COVERAGES CERTIFICATE NUMBER: 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 />AODL
<br />SUBR
<br />POLICY NUMBER
<br />MMIDDNYW CY EFF
<br />PMIO�YIYYYY
<br />LIMITS
<br />COMMERCIALGENERAL LIABILITY
<br />CLAIMS -MADE ® OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />D 'AGE RENTED
<br />PREMISES Eaoccuoence
<br />$ 100,000
<br />MED EXP (Any one person
<br />$ 5,000
<br />Abuse & Molestation (A&M)
<br />X
<br />Professional Liability (Prof. Llab)
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />Y
<br />PHPK2302279
<br />07/15/2021
<br />07/01/2022
<br />DEVIL AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY PRO- JECT Ej LOC
<br />PRODUCTS-COMPIOPAGG
<br />$ 2,000,006
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINEDSINGLE LIMIT
<br />Ea accident
<br />$ 1,OOQ000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Y
<br />Y
<br />PHPK2302279
<br />07/15/2021
<br />07/01/2022
<br />BODILY INJURY(Peracddenq
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY HAUTOS ONLY
<br />UMBRELLA DAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />$ 4,000,000
<br />A
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />Y
<br />Y
<br />PHUB777844
<br />07/16/2021
<br />07/01/2022
<br />OEO X1 RETENTION$ 10,000
<br />A&M and Prof. Liab.
<br />$ Included
<br />1
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY Y
<br />ANY OFFICERIMEMBEER EXCLUDED?ECUTIVE Y
<br />(Mandatory In NH)
<br />NIA
<br />Y
<br />TWC4004913
<br />07/15/2021
<br />07/01/2022
<br />PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<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 />A
<br />Blanket Business Personal Property
<br />Y
<br />PHPK2302279
<br />07/15/2021
<br />07/01/2022
<br />Limit of Insurance
<br />$112,000
<br />Deductible
<br />$ 500
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Additional Remarks Schedule, may be attached it more space is required)
<br />Re: Project Kinship
<br />City of Santa Ana, its officers, employees, volunteers, agents and representatives are named as Additional Insureds, on a primary and non-contributory basis,
<br />as respects to the above mentioned General Liability and Automobile Liability coverages as required by written contract, subject to policy terms and
<br />conditions. Notice of Cancellation - Each Insurance policy required above shall provide that coverage shall not be canceled, except with notice to the Entity.
<br />City Will be mailed 30 days written notice.
<br />Workers' Compensation Is evidence of insurance only.
<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 PROVISI^"1Q
<br />AUTHORIZED REPRESENTATIVE "I,
<br />`ri I�AEV/ED&APPROVm Br.
<br />NORA WOLKOFF 'I`'��j., ii:a Aecwa(a
<br />`�" Rttk NlanaycmertSpedvisr
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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