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Digitally signed
<br />ACOR& CERTIFICATE OF LIABILITY 1Q!fUR/,�1e
<br />`i D
<br />DATER^MIDDNYYYI
<br />7/26/2022
<br />THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND C Q!Nte: 70f TVI�TE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEN ERAG .A,�FQQR4 � BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETN_EN TtOdG'IN�IR(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(tes) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Harbor West Insurance Agency, Inc.
<br />31877 Del Obispo Street, Suite 211
<br />San Juan Capistrano, Ca 92675
<br />CONTACT
<br />NAME: rick keve
<br />P"oNE 949 768-1188 FAX 949 768-0543
<br />A/C No
<br />EHAAIL
<br />DD E rick(a@harborwestinsurance.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC9
<br />INSURER A: USLI
<br />25895
<br />INSURED
<br />INSURER
<br />INSURER C:
<br />Active Learning Believe and Inspire (ALBI)
<br />14 Suriside Ct
<br />Newport Beach, CA 92663
<br />INSURER D: USLI
<br />25895
<br />INSURER E: Teclnology Ins CO
<br />39071
<br />NSURER F
<br />COVERAGES CERTIFICATE NUMBER: 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 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />J=
<br />Min SUER
<br />POLICY NUMBER
<br />MMIDDYEFF
<br />MMIDD EXP
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />X
<br />NPP1612030
<br />7/01/22
<br />07/01/23
<br />DAMAGE TO RENTED
<br />PREMISES Ea rrenca
<br />$ 100,000
<br />MED EXP Any one person)
<br />$ 5,000
<br />PERSONAL SADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />POLICY
<br />7 PRO- LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />accitlent
<br />$
<br />UMBRELLALIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />AGGREGATE
<br />$ 2,000,000
<br />D
<br />V/
<br />EXCESSUAB
<br />CLAIMS -MADE
<br />X
<br />X
<br />XL1629428
<br />7/07/22
<br />07/07/23
<br />DED RETENTIONS
<br />$
<br />WORKERS COMPENSATION
<br />WC STATU- DTH-
<br />RY_LIM
<br />E
<br />AND EMPLOYERS' LIABILITY
<br />ANY OFFICER/MEM EREXCLUDED?ECUTIVE�
<br />(Mandatary In NH)
<br />9 yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />TWC4127501
<br />7/01/22
<br />07/01/23
<br />E.L. EACH ACCIDEM
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />1 $ 1,000,000
<br />Sexual Abuse/Molestation
<br />$ 1,000,000 Coverage
<br />A
<br />X
<br />X
<br />NPP1612030
<br />07/01/22
<br />07/01/23
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, greens space Is required)
<br />Certificate Holder, The City„ its officers, officials, employees and volunteers are covered as additional
<br />insureds. Policy is primary and non-contributory. Waiver of Subrogation is included
<br />Emy Frankston, Management Aide SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana, Parks, Recreation and Community Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza, Santa Ana, CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />(714) 647-5652 (0) 1 efrankston@santa-ana.org
<br />AUTHORIZED REPRESENTATIVE
<br />Rbk MmulgenadDtvlMgn
<br />[WIAVED&ATPROVm BY:
<br />©1988.2010 ACORD I =" � A-14 Ac o44
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD®` Risk Management Specialist
<br />
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