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Digitally signed byTod Pierson Tori Pierson Date: 2023.05.0808:14:29 -0TOU AC Rb® CERTIFICATE OF LIABILITY INSURANCE DATsi4/zozz 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 Burnham WGB Insurance Solutions CA Insurance License OF69771 15901 Red Hill Avenue TUSSIn CA 92780 - CONTACT NAME: Melissa I nelis PHONE 714-505-7000 FAX No:714-573-1770 nooRES, mignelis@wgbib.com INSURERS AFFORDING COVERAGE NAIC# INSURERA: Philadelphia Indemnity 18058 INSURED MERCY-0 Mercy House Living Centers, Inc. PO Box 1905 INSURER B: Berkshire Hathaway Homestate INsuRERc: INSURER D: Santa Ana CA 92702 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 1436081901 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. INSR LTR TYPE OF INSURANCE ADDLSUBR J= min POLICYNUMBER POLICYEFF MMIDDIYYYY POLICYEXP MM/DD LIMITS A X COMMERCIALGENERALLIABILITY CLAIMS -MADE _ OCCUR PHPK2409057 5/2/2022 5/1/2023 EACH OCCURRENCE $1,000,000 PREMIES RENTED PREMISES RENT nonce $100,000 MED EXP (Any one person) $ 5,000 PERSONAL SADV INJURY $1,000,000 AGGREGATE LIMIT APPLI ES PER: POLICY ❑ JECT PRO- ❑ LOG GENERALAGGREGATE $2,000,000 GENT X PRODUCTS -COMP/OPAGG $2,000.000 $ OTHER: A AUTOMOBILE LIABILITY PHPK2409057 5/2/2022 5/2/2023 COMBINED SINGLE LIMIT accident $1,000,000Ea BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Par accident) i e ) $ X HIRED N NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ A X UMBRELLALIAB X OCCUR PHUB812980 5/2/2022 5/2/2023 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION$ in nnn $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN MEWC338374 2JB/2022 2/8/2023 X STATUTE ERH E.L. EACH ACCIDENT $1,000,000 OFFCER/MEM EREXCLU ED?ECUTIVE ❑ NIA E.L. DISEASE - EA EMPLOYEE $1.000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $1.000,000 DESCRIPTION OF OPERATIONS below A A Professional Liability D80/EPLI PHPK2409057 PHSD1680830 5/2/2022 12/17/2021 5/2/2023 5/2/2023 1 Per Occunence(Agg Each Policy Period $1000000/$2000000 3,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Abuse/Molestation - Policy Number: PHPK2409057; Carrier: Philadelphia Indemnity; Limits: Each Abusive Conduct $1,000,000 / Aggregate $2,000,000 Umbrella Liability Schedule of Underlying: General Liability Policy: PHPK2409057; Auto Liability Policy: PHPK2409057; Professional Liability Policy: PHPK2409057 Certificate holder is named as additional insured on the General Liability per attached PI-GLD-HS (10/11) as required by written contract subject to the terms and conditions of the policy. Waiver of Subrogation applies to the General Liability per attached CG24040509 See Attached... City of Santra Ana Risk Management Division, 4th Floor 20 Civic Center Plaza Santa Ana CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. U 1988-2U15 ACORD C( ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Wdr714vugvnmtTMddm REYIE>iJ/ER6 APP�BY: NI %art {v&r