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Digital) signed
<br />.--., Angie I_T�TOG-DL14 APOHLMEYER
<br />ACC�RO"' CERTIFICATE OF L ec-AINGE.07.29
<br />`..•--'6/30/2022
<br />DATE (MM/DD/YYYY)
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO r U E 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 policy(ies) 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 endorsement(s).
<br />PRODUCER
<br />CONTACT Bethany Gilmore
<br />PHONE FAX
<br />(A/C, No, Ext): (480) 385-7336 , No):(480) 946-3512
<br />HUB International Insurance Services (SOW)
<br />4835 E Cactus Road Suite 246
<br />Scottsdale, AZ 85254
<br />E-MAIL bethany.gilmore@hubinternational.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Great American Alliance Insurance Company
<br />26832
<br />INSURED
<br />INSURERB: Philadelphia Indemnity Insurance Company
<br />18058
<br />THINK Together
<br />(a CA Non -Profit Corporation)
<br />INSURERC:
<br />2101 E 4th St, Bldg A
<br />INSURER D :
<br />INSURER E :
<br />Santa Ana, CA 92705
<br />INSURER F :
<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 />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE j OCCUR
<br />PAC5603740
<br />7/1/2022
<br />7/1/2023
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />1,000,000
<br />$
<br />X
<br />MED EXP (Any oneperson)
<br />$ 10,000
<br />Abuse
<br />X
<br />Molestation
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />POLICY JECT PRO-
<br />ElElLOC
<br />PRODUCTS - COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />X
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />CAP0521523
<br />7/1/2022
<br />7/1/2023
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />UMB5603741
<br />7/1/2022
<br />7/1/2023
<br />AGGREGATE
<br />$ 10,000,000
<br />DED X RETENTION $ 0
<br />Pr/Co Ops Aggr
<br />$ 10,000,000
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />PER OTH-
<br />STATUTE ER
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N/A
<br />E.L. EACH ACCIDENT
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />B
<br />Blkt Accident Policy
<br />PHPA110843
<br />7/1/2022
<br />7/1/2023
<br />$50,000 Med w/AD&D @
<br />50,000
<br />A
<br />Professional Liab
<br />PAC5603740
<br />7/1/2022
<br />7/1/2023
<br />$1m ea claim w/Aggr
<br />3,000,000
<br />DESCRIPTION OF OPERATIONS / 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: CG8970 11/14 & CA8620 05/16.
<br />SEE ATTACHED ACORD 101
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ty ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />PO Box 1988
<br />Santa Ana, CA 92702-1988 AUTHORIZED REPRESENTATIVE
<br />jp ,n cERisk kluagmentDD BY
<br />° REVIEWED & APPROVED BY:
<br />ACORD 25 (2016/03) © 1988-2015 ACORD I �l f"°
<br />The ACORD name and logo are registered marks of ACORD '— ��— Risk Management specialist
<br />
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