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<br />On121292021
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<br />,4`iR0 CERTIFICATE OF LIABILITY INSURANCE
<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(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 endorsements .
<br />PRODUCER
<br />CONTACT
<br />Bolton Insurance Services LLC
<br />3475 E. Foothill Boulevard - -
<br />Suite 100
<br />PHONE FA%
<br />NC, No, Ezt: (626) 799-7000 AIC, Nq :(626) 441-3233
<br />E-MAIL
<br />Pasadena, CA 91107 -
<br />- --
<br />INSURERS AFFORDING COVERAGE
<br />NAIC 71
<br />INSURER A: TOIdo Marine Specialty Insurance Company
<br />23850
<br />INSURED
<br />INSURERB:American Healthcare Indemnity Company
<br />39152
<br />INSURER C:Philadelphia Indemnity Insurance Company
<br />18058
<br />Wiseplace, CA Corp. Wise Silver Center dba: -
<br />INSURER D
<br />1411 N. Broadway
<br />Santa Ana, CA 92706 -
<br />INSURER E:
<br />INSURER F
<br />rr1VCRAG9e 1-COTICIr ATC rU11IIlICCG• r_lncrnsr wuauce.
<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 MAY BE ISSUED OR MAY PERTAIN, THE INSURANCEAFFORDED 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 />TYPE OF INSURANCE
<br />ADDL
<br />SUBRMD.
<br />pOLICTTJUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIALGENERALLIABILRY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />PHPK2357926" -
<br />111/2022
<br />1/112023
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />EMISES Eaoc u
<br />$ 700000
<br />MED EXP (My... rson
<br />5,000
<br />- -i C..
<br />PERSONAL&ADV INJURY
<br />1+000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER
<br />POLICY❑j T LOD
<br />GENERALAGGREGATE
<br />2,000,000
<br />--- -
<br />_
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />SEXUAL PHYSICAL
<br />1,000,000
<br />OTHER:
<br />_
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident$
<br />1 �ggg ggg
<br />BODILY INJURY Perperson)$
<br />AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />PHPK2357925
<br />--
<br />_-
<br />111/2022
<br />11112023
<br />IxANY
<br />BODILY INJURY Per accident
<br />$
<br />Pa?PCE'R t AMAGE
<br />§
<br />AUTOS ONLY X AUTOS ONLY
<br />- -
<br />A
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />--''-"
<br />PHUB795965�`�0�-
<br />- 11112022
<br />11112023
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />DED X RETENTION$ 10,000=hY
<br />Personal &Adv
<br />1,000,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />? FF1dERi MEM1N1�EXCWDED?
<br />OF Dyes,describerde,O
<br />DESCRIPTION
<br />IPTIOPERATIONSbelow
<br />NIA
<br />_ -��"'
<br />SATIS0324601^ ---
<br />-- - ._
<br />---
<br />8115/2021
<br />8/1512022
<br />PER OT
<br />Vt H-
<br />STAT E ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />1,000,000
<br />E.L DISEASE -PODGY LIMIT
<br />11000,000
<br />A
<br />C
<br />Professional Liab. -
<br />Employee Theft
<br />PHPK2357925- _ -
<br />PHSD1616664 _-__
<br />1/112022
<br />515/2021
<br />1/1/2023
<br />619/2022
<br />Occurrence
<br />1,000,000
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS LOCATIONS /VEHICLES (ACORD 101, AddiBdnsl ROinerifs$chetlule, maybe attached if more space is required)
<br />GL Additional Insured applies per CG20130413 attachedronlyif required by written contract/agreement.
<br />Primary and Non -Contributory Wording applies per PIGL0050712'afta8hed-.
<br />Notice of Cancellation applies per IL00171198 attached; -- ---- --_ -----
<br />Additional Insured(s): Cify of Santa Ana, its officers, employees, ageri}9; volunteers and representatives.
<br />RE: Operations of the named Insured.
<br />CERTIFICATE HOLDER CANCELLATION
<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 />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, 4th floor
<br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE
<br />. Vrlr Risk MartsgamodDlaisiml
<br />�• (r '7 g4^ REvtE S APPROVED BY:
<br />ACORD 25 (2016/03) ©1988-2012015 ACORD C R' v`l
<br />-�' The ACORD name and logo are registered marks of ACORD Ruk Management Anayst
<br />
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