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�® CERTIFICATE OF LIABILITY INSUIwie Digitallysgn®TtE(MbvoDYTYY) <br />by An ie <br />07/14/2022 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO/�p*SI�GFFtI,T�FSyy`U'PF�RN+ . IA(Q%Tl@CATE HOLDER. THIS <br />BELOWCERTIF.TE DOES NOT THISCERTIFICATE FOFNNSURANCE DOES NOTVELY OR LY AMEND, CO STTUTEXAEND OR CONTRACT BETWEEN THE 1;SU ' RDED BY THE POLICIES <br />RER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 2022.08.11 <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have DITIO'JP.L INSURE7E2itWsidri�O0r 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 Nora Wolkoff <br />NAME: <br />PNONE 323-805-2918 FAX o: <br />Dickerson Insurance Services an Alera Group Company <br />AIL <br />ADDRESS, Nora@dickerson-group.com <br />1918 Riverside Drive, Los Angeles, CA 90039 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />License #OM29112 <br />INSURERA: Philadelphia Indemnity Insurance Company <br />18058 <br />INSURED <br />INSURERS: SERVICE AMERICAN INDEMNITY COMPANY <br />39152 <br />INSURERC: <br />Charitable Ventures of Orange County <br />INSURER D: <br />1505 E. 17th Street, Suite 101 <br />INSURER E: <br />Santa Ana, CA 92705 <br />NSURERF: <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 />TR <br />TYPE OF INSURANCE <br />JUL ADDL <br />Me SUER <br />POLICY NUMBER <br />MMI��VIYEYri <br />POLICY UP <br />MMIDENYYYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />® OCCUR <br />DAMAGCLAIMS-MADE <br />PREMIES(E. RENTED <br />PREMISES TO RENTErenca <br />$ 100,000 <br />MED EXP (Any one person) <br />$ 5,000 <br />Abuse & Molestation (A&M) <br />X1 <br />Professional Liability(Prof. Liab) <br />PERSONAL &ADV INJURY <br />$ 1,000,000 <br />A <br />Y <br />PHPK2419226 <br />07/01/2022 <br />07/01/2023 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />POLICY D jETElLoc <br />PRODUCTS-COMP/OP AGO <br />$ 2,000,000 <br />$ <br />OTHER'. <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accitlent <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />A <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />Y <br />PHPK2419226 <br />07/01/2022 <br />07/01/2023 <br />BODILY INJURY (Per accident) <br />$ <br />HIRED NONOWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Peraccident <br />$ <br />$ <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE <br />$ 4,000,005 <br />AGGREGATE <br />$ 4,000,000 <br />A <br />EXCESS LAB <br />CLAIMS -MADE <br />Y <br />PHUB816379 <br />07/01/2022 <br />07/01/2023 <br />DED RETENTION$ 10,000 <br />A&M and Prof. Liab. <br />$ Included <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />OFFICER/MEMBERANY IEXCLUERIE EGUTIVE YIN <br />(Mandatory in NH) <br />NIA <br />Y <br />SATIS0511000 <br />07/01/2022 <br />07/01/2023 <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />If es, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />Clerk of the City Council Cityof Santa Ana is recognized as an additional insured with respect to the operations for the name insured subject to policy terms and <br />conditions. <br />Evidence only as respects to Workers Compensation. <br />We may cancel this Policy by mailing or delivering to the first Named Insured written notice of cancellation at least: Ten (10) days before the effective date of <br />cancellation if we cancel for non-payment of premium; or Thirty (30) days before the effective date of cancellation if we cancel for any other reason. <br />Clerk of the City Council City of Santa Ana <br />20 Civic Center Plaza (M-30) <br />P.O. Box 1988 <br />Santa Ana, CA 92702-1988 <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 />AUTHORRED REPRESENTATIVE <br />NORA WOLKOFF <br />©1988-2015 ACORD <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />REv EWER 6 APFNWEO BY: <br />A f, Ad"44 <br />Risk Management Specialist <br />