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.d►�oRo CERTIFICATE OF LIABILITY INS6WANCE Dig <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANDC FE G T P r E' <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEN�L% • : AI <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A C E .UINC <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL ,NGUREI <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the polio , rtain policies may rf {uire an ei <br />this certificate does not confer rights to the certificate holder in lieu of such endo a ants . <br />PRODUCER O T ethanyGilmo'e <br />HUB International Insurance Services (SOW) PHONE <br />... _ IAIc. N„_ F.I. (4801385-7336 <br />INSURED <br />THINK Together <br />(a CA Non -Profit Corporation) <br />2101 E 4th St, Bldg A <br />Santa Ana, CA 92705 <br />COVFRAr:FS CFRTIFICATF MIIMRFR- oF1n¢Ir1M MTTMRCR. <br />A statement on <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 />TYPE OF INSURANCE <br />ADDLSUBR INSO <br />WAD <br />POLICY NUMBER <br />POLICY EFF <br />POLICCY EXPLIR <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE a OCCUR <br />Abuse <br />PACS603740 <br />7/1/2021 <br />7/112022 <br />EACH OCCURRENCE <br />1,000,000 <br />DAEAGE TO RENTED <br />1,00000g <br />X <br />MED UP (My one arson <br />10,000 <br />X <br />Molestation <br />PERSONAL&ADV INJURY <br />1000000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER <br />POLICY ma LOC <br />GENERAL AGGREGATE <br />3:000:000 <br />PRODUCTS - COMP/OP AGG <br />S 2,000,000 <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />1.000000 <br />X <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />CAP0521523 <br />7/112021 <br />7/112022 <br />BODILY INJURY Per arson <br />BODILY INJURY (Per accident <br />A0PP.ER Yt AMAGE <br />AAIUOSON AIRED <br />ONLY <br />A <br />X <br />UMBRELLALIAS <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 10,000,000 <br />AGGREGATE <br />10,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />UMB5603741 <br />7/112021 <br />7/112022 <br />DED X RETENTION$ 0 <br />Pr/Co Ops Aggr <br />10,000,000 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORBPARTNERIEXECUTIVE <br />WFICER/MEMBER EXCLUOEDP <br />NIA <br />I PER OTH- <br />E.L. EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYE <br />(Mandatory in NH) <br />IF yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />B <br />Blkt Accident Policy <br />BSR1466634-04 <br />7/1/2021 <br />71112022 <br />$25,000 Med w/AD&D @ <br />50,000 <br />A <br />Professional Liab <br />PAC5603740 <br />7/112021 <br />711/2022 <br />$1m Be claim w/Aggr <br />3,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) <br />RE: American Rescue Plan Act (ARPA) Funds. <br />Certificate Holder, Owner and all others as required by written contract are Additional Insured(s) on a Primary Non -Contributory basis including Waiver of <br />Subrogation With respects to General Liability per attached endorsements. Commercial Auto Liability Additional Insured including Waiver of Subrogation <br />applies per attached endorsements. Umbrella Liability is Excess over General Liability, Abuse/Molestation, Professional Liability, Auto Liability, and Workers <br />Compensation. <br />APPLICABLE FORMS ATTACHED: CG897011/14 & CA8620 05116. <br />SEE ATTACHED ACORD 101 <br />City of Santa Ana <br />20 Civic Center Plaza <br />PO Box 1988 <br />Santa Ana, CA 92702-1988 <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 REPRESENTATIVE <br />ACORD 25 (2016/03) 01988-2015 ACORD <br />The ACORD name and logo are registered marks of ACORD <br />\i <br />Xi/k iiYnife11101ttXViBiell <br />REVIEWED 6 APPRovM O: <br />Ay:rA�� <br />- <br />Risk Management Specialist <br />of <br />