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<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION QAW AND CONFERS NC f �( 11�G I ,('):R/'t� l(p � THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTE < T,'E COVERAGE -AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES ROT CONSTITUTE A CONTRA T ',ETW p S
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTFF E D l�e SDIt%g'IIIS71IR6). 111lNiORIZED
<br />IMPORTANT: If the certificate holder is an ADDITIO RE c us t ve DTI N LaJ Lpr I 44eVendorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms d c n th pot , c p Ie�ME' s (r18}�e i � idlT r tatement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorser,ent(s).
<br />PRODUCER
<br />CalNonprofits Insurance Services
<br />1500 41st Avenue
<br />Suite 228
<br />Capitola CA 95010
<br />INSURED
<br />CIC Human Relations Council
<br />1801 E Edinger Ave, Ste. 115
<br />Santa Ana CA 92705
<br />COVERAGES CERTIFICATE NUMBER: 1861572434 REVISION NUMRFR-
<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 />INSIR TR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICYNUMBER
<br />MMIODYEFF
<br />MMIDDITPOLIY YXYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE E OCCUR
<br />Y
<br />PHPK2388116
<br />4/26/2022
<br />4/26/2023
<br />EACH OCCURRENCE
<br />$1,0D0000
<br />DAMAGE TO RENT
<br />PREMISES Eaoccunence
<br />$100,000
<br />MED UP (Any one person)
<br />$ 5,000
<br />PERSONAL B ADV INJURY
<br />$1,000,000
<br />DEVIL
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY JECOT LOG
<br />GENERALAGGREGATE
<br />$2,000;000
<br />PRODUCTS - COMP/OP AGO
<br />$1,000,000
<br />I Deductible
<br />$0
<br />OTHER:
<br />A
<br />AUTOMOBILELABILITY
<br />PHPK2388116
<br />4/26/2022
<br />4/26/2023
<br />COMBINED SINGLE LIMIT
<br />Ea accident)
<br />$1,D00,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Per accitlent
<br />BODILY INJURY ( )
<br />$
<br />X
<br />HIRED X AUTOSNON-OWNED LY
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY ogMAGE
<br />Per accitlent
<br />$
<br />Deductible
<br />$ 0
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACHOCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />B
<br />WORKERSCOMPENSATION
<br />ANDEMPLOYERS`LIABILITY Y/N
<br />57WECANIML7
<br />10/1/2021
<br />10/1/2022
<br />X STATUTE ETH
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />ANYPROPRIETOR/PARTNEWEXECUTIVE N
<br />OFRCERIMEMBER EXCLUDED 9
<br />NIA
<br />E.L DISEASE -EA EMPLOYEE
<br />$1.000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,DOG OGO
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />C
<br />A
<br />Professional Liability
<br />Cyber liability
<br />$emaVPhysiral Abuse
<br />PHPK2388116
<br />CYB108313
<br />PHPK2388116
<br />4/26/2022
<br />12/15/2021
<br />4/26/2022
<br />4/26/2023
<br />12/15/2022
<br />4/26/2023
<br />Each Occ./Aggregate
<br />Aggregate
<br />Each Claim/Aggregate
<br />$1M / $2M
<br />$1,000,000
<br />$1M/$2M
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Employee Theft: Limit $100,000 Per Occurrence, Deductible $1,000; Philadelphia Indemnity Insurance Company, policy # PHPK2388116, Eff Date 4/26/2022 to
<br />4/26/2023.
<br />Business Personal Property: Limit $70,000, Deductible $500; Special Form, Replacement Cost, 90% Coinsurance; Philadelphia Indemnity Insurance Company,
<br />policy # PHPK2388116, Eff Date 4/262022 to 4126/2023.
<br />City of Santa Ana, officers, agents, employees, and volunteers are included as Additional Insured with respect to General Liability as required by written
<br />contract per Endorsement Form PI-GLD-HS attached. General Liability coverage is Primary & Non-contributory, per Endorsement Form PI-GL-005 attached.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702
<br />CANCELLATION
<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 />©1988-2015
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />RIAMw6anmtDtWalmt
<br />p REVIEwEnfi/NPRw®BY
<br />Risk Management Specialist
<br />
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