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Digitally signed by Toni Pierson <br />Tor( Person orts: 2022,06.2110:49:02 <br />-0700' <br />A60R' CERTIFICATE OF LIABILITY INSURANCE <br />ll.� <br />DATE IMM/DD/YYri) <br />06/14/2022 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE 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(les) 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 <br />NAME: <br />My Protection LLC <br />101 Gibraltar Or Suite 3A <br />PH$NN ke. (888) 202-3007 ac No), <br />ADDRESS: contact@hiscox.com <br />INSURERS AFFORDING COVERAGE <br />NAIC q <br />Morris Plains NJ 07950 <br />INSURER A: HIscox Insurance Company Inc <br />10200 <br />INSURED <br />KFB Management <br />27 Gathering Hill Court <br />INSURER B <br />INSURER C: <br />INSURER D: <br />Morris Plains, NJ 07950 <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: REVISION NHMFU R- <br />POLICY PERIOD <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOiRESPECT <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITTO WHICH THISCERTIFICATE <br />MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SALL THE TERMS,EXCLUSIONSAND <br />CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSIR <br />TYPE OF INSURANCE <br />ADDLSUBR <br />p <br />POLICYNUMBER <br />POLICYEFF <br />MMIDDf/YYY <br />POLICYEXPLTRJum <br />MMIDD/YYri <br />X <br />COMMERCIAL GENERAL LIABILITY <br />IOCCUR <br />EACH OCCURREN1,000,000CLAIMS-MADE <br />DA AGETORENPREMISES Ea oc100,000MED <br />EXP(Any on5,000 <br />PERSONAL&ADV INJURY <br />$ 0 <br />A <br />Y <br />Y <br />P100.325.866.2 <br />06/11/2022 <br />06/11/2023 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY JECTP"- LOC <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN'L <br />X <br />PRODUCTS-COMP/OP AGO <br />$ 2,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />Per accitlent <br />BODILY INJURY ( ) <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY -DAMAGE <br />Per accident <br />$ <br />UMBRELLALIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAR <br />CLAIMS -MADE <br />LED RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y/N <br />ANYPROPRIETOR/PARTNERIEXECUTIVE <br />OFFICER/MEMBER EXCLUDED? ❑ <br />N/A <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />(Mandatoryin NH) <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS below <br />A <br />Professional Liability <br />X <br />P100.323.448.2 <br />6/11/2022 <br />06/11/2023 <br />Aggregate <br />$ 2,000,000 <br />Per Occurance <br />$ 2,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD tot, Additional Remarks Schedule, maybe attached if more space is required) <br />Cityof Santa Ana, its officers, employees, agents and representatives are additional Insured with respect to the General Liability Policy Per the attached endorsement or by writ- <br />ten contract. Insurance is primary and noncontributory and includes a Waiver of Subrogation. 30 days notice of cancellation with 10 days noticeof non payment of premium in <br />accordance with the policy provisions. The City of Santa Ana, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with <br />respect to liability arising out of work cr operations performed by or on behalf of the Contractor including materials, parts, or equipment furnished in connection with such work or <br />operations. <br />City of Santa Ana <br />Risk Management Division, <br />20 Civic Center Plaza <br />Santa Ana CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, 30 DAY NOTICE WILL BE <br />DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />©1988-2015 <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of AC <br />O <br />ACORD CORF <br />RD RrskMana9en,c+rc OnimiAide <br />