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ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 03/06/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA PHONE 888 202-3007 FAx AC Ex : ( ) AIC No: 520 Madison Avenue IL E-MAIL mntact@hiswx.com Aooasss: 32nd Floor INSURERS AFFORDING COVERAGE NAIC 9 New York, New York 10022 INSURER A: Hiscox Insurance Company Inc 10200 INSURED INSURER a : 360Civic 1835 W Orangewood Avenue #255 INSURERC Orange, CA 92868 INSURER o : INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL D SUER WO POLICYNUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/ODAr LIMITS COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ CLAIMS -MADE ❑ OCCUR PREMISES Ea occu ante $ MED EXP (Anyone person) $ PERSONAL&ADV INJURY $ AGGREGATE LIME APPLIES PER: GENERALAGGREGATE $ GEN'L POLICY PRO-ECT LOC PRODUCTS-COMP/OPAGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OPMED SCHEDULED AUTOS AUTOS BODILY INJURY(Far accident) $ NONOWNED HIREDAUTOS AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LAB OCCUR EACHOCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERTLIABILITY YIN PER OTH. STATUTE ER ANYPROPRIETORIPARTNERIEXECUTIVE E.L EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED4 ❑ NIA E.LDISEASE-EAEMPLOYE $ (Mandatory in NH) tl yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT $ A Professional Liability Y Y P100.367.850.1 02/01/2022 02/01/2023 Each Claim: $1.000,000 Aggregate: $ 2,000.000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Those usual to the Insured's Operations. The City of Santa and its officers, employees, agents, and representatives are named as additional insureds City of Santa Ana 20 Civic Center PLZ FL 4 Santa Ana, CA 92701-4058 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE y Wit Mara,ganmt gNdm Renerin& M ctce . ©1988-2015 ACORD C( h. MmugevmmciralAlde ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD