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ACORH CERTIFICATE OF LIABILITY INSURANCE ll.� 9/l/2022 F DATE(NIMnDNYYY) 1 11/9/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy()es) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockton Insurance Brokers, Inc. 400 Capitol Mall Avenue, Suite 2600 Sacramento CA 95814 (213) 689-0550 CONTACT NAME: PHONE FAX ac Na: E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIGp INSURER A: IronshoreSpecialty Insurance Co 25445 INSURED Halcyon Behavioral, LLC 1499172 1080 W Shaw #105 INSURER B: North American Capacity Insurance Co 25038 INSURER C: FIesno CA 97311 INSURER D : 11 INSURER E: INSURER F: COVERAGES PHYCL03 CERTIFICATE NUMBER: 17999165 REVISION NUMBER- YvxxxYv THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE ADDL SUER POLICYNUMBER POLICY EFF MMIDDTYYYY POLICY EXP MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXX){ -DAUVES(TO RENTED PREMISES EeoccuD $ i{i{i{i{}{}(}{ MEP EXP (Anyone person) $ XXXXXX){ PERSONAL S ADV INJURY $ XXXXXXX GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ XXXXX) x POLICY PRO- LOC ECT PRODUCTS- $ }Q{Y{}_X X It OTHER: AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT Ea accident $ XXXX){XX BODILY INJURY (Per parson) $ ]{){){yX'X){ ANY AUTO OWNED SCHEOULEp AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ XXXXXXX HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ XXX)O $ XXXXX) x UMBRELLA LIAB OCCUR NOTAPPLICABLE EACH OCCURRENCE $ XXXX)XSXX AGGREGATE $ X)DCX= EXCE5S LIAB CLAIMS -MADE pEO I RETENTION$ $ xx {){xxx WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PRCPRIETOWPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUCED9 ❑ NIA NOTAPPLICABLE PER FIR STATUTE ER E.L. EACH ACCIDENT $ XXXXXXX E.L. DISEASE - EA EMPLOYEE $ XXXXXXX (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT S XXXXXXX A Managed Care E&O Liability N N HC7CAB4HM9002 10/292021 10/29/2022 $1M/$2M B —Prim C-4LRK-041319-CYBER-2021 9/l2021 9/1/2022 $3M Cyber DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space Is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLETO THE CARRIERS LISTEDAND THE POLICY TERM(S) REFERENCED. HOLDER 17899365 City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 ACORD 25 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED r nuesmrmagc ciudmason �le�l�� I ' ��,, REVIEWEDSAPPROVBDBY: ©f 88-261Ac D c , i'' The ACORD name and logo are registered marks of ACORD ' auk Management Analyst