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Tori Pierson oaienAeBID'onuuIew A O ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDNYYY) n l�rzun 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 Irvine CA 92614 CONTACT NAME: PHONE .949-771-3400 FUA"c , :949-771-3401 EHAatL ADD S INSURERS AFFORDING COVERAGE NAIC# INSURER A: Philadelphia Indemnity Insurance Company INSURERS; 18058 License : 0564249 INSURED ORANCOU-05 Orange County's United Way 18012 Mitchell South INSURERC: Irvine CA 92614-6008 NSURER O: INSURER E : INSURER F: 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 ADOLSUSR POLICY NUMBER MLOUDU DY EFF MMNCY EXP LIMITS A X COMMERCIAL GENERAL LIABILRY CLAIMS -MADE OCCUR Y PHPK2320247 I 11/1/2021 11/1/2022 EACH OCCURRENCE $1.000,000 D ETOR TE PREMISES LEa occurrence MED EXP Any one Parson $1,000.000 $20,000 PERSONAL& ADV INJURY $1.000,000 GENII, X AGGREGATE LIMIT APPLIES PER: POLICY 0 J CT LOC OTHER: GENERAL AGGREGATE $3.000,000 PRODUCTS-COMP/OPAGG $3,000.000 It A AUTOMOBILE LUU$ILIW O OWNED WNEDrO SCHEDULED AUTOS ONLY AUTOS HIRED X NON-OWNEDPROPERTY AUTOS ONLY AUTOSSONLYLY PHPK2320247 11/1/2021 11/l/2022 COMBINED SINGLE LIMITANY PE, accident) $1,000,000 BODILY INJURY(P., pemon) $ BODILY INJURY (PereWtlanl) E X DAMAGE er a¢Ident E a A X UMBRELLADAB EXCESS LIAR X OCCUR CLAIMS -MADE NIA PHUB783584 11/1/2021 11/1/2022 EACH OCCURRENCE E5,000,000 AGGREGATE $5,000,000 DED I X I RETENTION$ WORKERS COMPENSATION ANDEMPLOYERS'LUIBILITY YIN ANYPROPRIETORIPARTNEMEXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) UnE.L. desomm under RIAONOFOPERATIONSbelm OT STATUTE ER $ E.L. EACH ACCIDENT $ DISEASE -EA EMPLOYE E EA_DISEASE- POUCYLIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it 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. 'RESENTATNE L,ti,. / REve & ArgrOa®Br iou- ✓i[stoa (7r. IAAR-2B15 Ar'nion ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD If - —�