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Tori Pierson Digitasigned by' a Pierson
<br />.121.11.16 12:15:59 "0'
<br />AC40J? CERTIFICATE OF LIABILITY INSURANCE
<br />DAM(MM/DD/Y)YY)
<br />1
<br />`/
<br />11/02/2021
<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 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 Certificate Issuance Team
<br />NAME:
<br />Comprehensive Insurance Services
<br />PHONE (949) 709-8800 pIc (949) 709-1668
<br />No :
<br />26429 Rancho Parkway South
<br />E-MAIL jeremy@thecompmhensiveinsumnce.com
<br />ADDRESS:
<br />Suite 120
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC9
<br />Lake Forest CA 92630
<br />INSURER A: Nonprofits Insurance Alliance of California
<br />10023
<br />INSURED
<br />INSURER a StarNet Insurance Company
<br />40045
<br />Delhi Center
<br />INSURER C :
<br />505 E. Central Ave.
<br />INSURBR D
<br />NSURERE:
<br />Santa Ana CA 92707
<br />1INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: CL2111205495 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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 />ADDLSUSK
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIODIYYYY
<br />POLICY UP
<br />MMM
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />�
<br />A A ETO
<br />PREMISES Ea omunence
<br />$ 500,000
<br />CLAIMS -MADE OCCUR
<br />NED EXP (Any oneperson)
<br />$ 20,000
<br />PERSONAL BADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />2021-01376
<br />11/012021
<br />11/01/2022
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />GENERALAGGREGATE
<br />$ 3,000,000
<br />POLICY F7 jE6 Ex-11LOC
<br />PRODUCTS.COMP/OPAGG
<br />If 3,000,000
<br />OTHER:
<br />1
<br />$0 Deductible
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMB
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />2021-01376
<br />11/01/2021
<br />11/01/2D22
<br />BODILY INJURY (Per acodenq
<br />$
<br />HIRED NON -OWNED
<br />P
<br />-
<br />PROPERTYDAMAGE
<br />AUTOS ONLY AUTOS ONLY
<br />eraccident)$
<br />$0 Deductible
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />PER OTH-
<br />STATUTE I ER
<br />$O Deductible
<br />AND EMPLOYERS' LIABILITY YIN
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />B
<br />ANY PROPRIETORIPARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />MIA
<br />BNUWC0152622
<br />11/01/2021
<br />11/01/2022
<br />E.L. DISEASE -EA EMPLOYEE
<br />S 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS helm
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />$3,000,000/1,000,000
<br />Aggregate/Occum.
<br />Social Service Professional Liability
<br />A
<br />Improper Sexual Conduct Liability
<br />2021-01376
<br />11/01/2021
<br />11/01/2022
<br />$1,000,00011,000,000
<br />Aggregate/Occurr.
<br />$0 Deductible
<br />DESCRIPTIONOFOPERAMONS/LOCATONSIVEHICLE$ (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Cityof Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or
<br />memorandum of understanding per attached endorsement CG2026. Such insurance as is afforded by this policy shall be primary, and any insurance carried
<br />by City shall be excess and noncontributory per attached endorsement NIAC E61. 30 day notice of cancellation with 10 day notice of cancellation for
<br />non-payment of premium per policy provision.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana
<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 Itit Mrra�ned ghyica
<br />1✓EV&aran6 APPROJm Br:
<br />CA 92702`_kIIjD'. t(r1,1 �fdu �rctJo.r
<br />Imm-
<br />a) 19811-2015 ACORn
<br />ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD N
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