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A-2021-107-03A Tori Pierson Dlgltallysigned by'ronPamon Dat¢ 202IJ1.09 ni25:42 ,0V a�oizo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 11/3/2021 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(ies) 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 (OC) Heffernan Insurance Brokers 18004 Sky Park Circle, Suite 210 CONTACT NAME, 949-771-3400 FAixc Ha ; 949-771-3401 Irvine CA 92614 EMAIL ADDR SS: INSURERB AFFORDING COVERAGE NAIC# INSURER A: Philadelphia Indemnl Insurance -----ny 18058 Lice se#: 05642 9 INSURED ORANCOU-05 Orange County's United Way INSURER B: INSURERC: 18012 Mitchell South Irvine CA 92614-6008 INSURER D: INSURER E INSURER F : COVERAGES CERTIFICATF NIIMRFR-1A1DD11999 oclnc,nsr uuue.-... 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. INTR _ TYPE OF INSURANCE ADDL BUSH POLICYNUMBER POLICY EFF MMIDD POLICY EXP MM/DD LIMITS A TCOMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y PHPK2320247 11/1/2021 11/1/2022 EACH OCCURRENCE $1,000,000 D A ETORE D PREMISES Ea occurrence $1,000,000 MED EXP Any one person) $20,D00 PERSONAL&ADV INJURY $1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY JPECT LOC GENERALAGGREGATE $3,000,000 PRODUCTS-COMP/OP AGG $3,000.000 $ OTHER I A AUTOMOBILEUMILITY PHPK2320247 11/1/2021 11/1/2022 COMBINED SINGLELIMIT Ea acddent $1,000.000 AUTO BODILY INJURY (Par person) $ IDAMAANY OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Par accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY GE PBOPEERTYcoldY $ A X UMBRELLALIAB X OCCUR PHUB783584 11/1/2021 11/1/2022 EACH OCCURRENCE $5,000. DOD AGGREGATE $ 5,000,D00 EXCESS LIAB CLAIMS -MADE DED X RETENTION$ $ WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNER/E(ECUTIVE OFFICERIMEMBEREXCLUDED9 N/A IPER I OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ (Mandatory In HE) If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddiUonal Remarks Schedule, may be attached if more space is required) Re: Agreement #A-2021-107-03, CARES for Tenants Program (ERAP Funds). City of Santa Ana, officers, agents, employees, representative and volunteers are included as an additional insured (primary and non-contributory) on General Liability policy per the attached endorsements, if required. Cancellation notice endorsement on the General Liability policy is attached, If required. This Certificate replaces and supersedes all previously issued certificates. City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 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 REPRESENTATIVE 'EPESSRisk McnagamedDNdm - 'u =%o1i Yre1,'u rn 10RR-9nlS arnGn rr Ruk MavgenmrGviW Nde ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD L, —�