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<br />Tori Pierson OaOtetta11021.11.161214:43e08oir
<br />A� O® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMOD2rc1YY)
<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(tes) 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 />PHDNE Exi (949) 709-8800 Fn,c No (949) 709-1668
<br />E
<br />26429 Rancho Parkway South
<br />aess: JeremyWthecomprehensiveinsurance.com
<br />Suite 120
<br />INSURERS AFFORDING COVERAGE
<br />NAIC C
<br />Lake Forest CA 92630
<br />INSURERA: Nonprofits Insurance Alliance of California
<br />10023
<br />INSURED
<br />INSURER B: StarNet Insurance Company
<br />40045
<br />Delhi Center _
<br />INSURER C:
<br />505 E. Central Ave.
<br />INSURER D
<br />INSURER E:
<br />' -
<br />Santa Ana CA 92707
<br />INSURER 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 />ADDL
<br />INSD
<br />SUER
<br />Who
<br />POLICYNUMBER
<br />POLICY EFF
<br />(MMMDNyyyl
<br />POLICY Exp
<br />MMID
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />URRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE Z OCCUR
<br />Ea occurrence
<br />$ 500,000
<br />An one rson
<br />$ 20,000
<br />SADV INJURY
<br />M
<br />$ 1,000,000
<br />A
<br />Y
<br />2021-01376
<br />11/01/2021
<br />11/01/2022
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />GGREGATE
<br />$ 3,000,000
<br />POLICY ❑JECTT 19 LOC
<br />-COMPIOPAGG
<br />$3,000,000
<br />OTHER:
<br />tible
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />SINGLELIMIT
<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 />11/01/2022
<br />BODILY INJURY Per accident)
<br />$
<br />x
<br />HIRED NON -OWNED
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />AUTOS ONLY AUTOS ONLY
<br />$0 Deductible
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMSMADE
<br />DELI
<br />I I RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />PER OTH-
<br />STATDTE ER
<br />$O Deductible
<br />AND EMPLOYERS' LIABILITY Y IN
<br />E.L. EACH AC CIDENT
<br />It 1,000,000
<br />B
<br />ANY PROPRIETORIPARTNERIEXECUTIVE [E
<br />NIA
<br />BNDWC0152622
<br />11/01/2021
<br />11 /01/2022
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />EL.DISEASE-EA EMPLOYEE
<br />It 1,000,000
<br />Ryes, Cescdbe under
<br />DESCRIPTION OF OPERATIONS balm
<br />-
<br />E . DISEASE. POLICY LIMIT
<br />8 1,000,000
<br />$3,000,000/1,000,000
<br />Aggregate/Occurr.
<br />Social Service Professional Liability
<br />A
<br />Improper Sexual Conduct Liability
<br />2021-01376
<br />11/01/2021
<br />11/01/2022
<br />$1,000,000/1.000,000
<br />Aggregate/Occurr.
<br />$0 Deductible
<br />DESCRIPTION OFOPERAGONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policypursuant to written Contract, agreement, or
<br />memorandum of understanding per attached endorsement CG2026. Such insurance as is afforded by this policy shall he 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 Rik Mrrnpnml Dr.
<br />///��� I2i4ecen6/IrrRo2Fn Br:
<br />CA 92702
<br />%u Prccddv
<br />n 19RR-2015 ACORD amrNt„,ase,a,„romulaae
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD V 11
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