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Digitally signed by Tod Pierson Torj PjersonDets: 2022D6.0 00:14:29 -Gr00' CERTIFICATE OF LIABILITY INSURANCE DAM A (MNUP2YYY) D 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 CONTACT NAME: Melissa I nelis PHONE FAX . 714-505-7000 1,c No : 714-573-1770 EAMAR'LEss. mi nelis w bib.com 15901 Red Hill Avenue Tustin CA 92780 INSURERS AFFORDING COVERAGE NAIL# INSURERA: Philadelphia Indemnity 18058 INSURED MERCY-1 Mercy House Living Centers, Inc. PO Box 1905 INSURER B : Berkshire Hathaway HOmestate INSURER C: 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. LTR TYPE OF INSURANCE ADOL SUER POLICYNUMBER MMIDDY� MOLIC EXP LIMITS A X COMMERCIALGENERAL LIABILITY PHPK2409057 5/2/2022 5/1/2023 EACH OCCURRENCE $1,000,000 CLAIMS -MADE I OCCUR DAMAG TO E ED PREMISES Ea oocunenca $100,000 MEDEXP(Anyonsimmon) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PRO-JECT ❑ LOD PRODUCTS-COMP/OPAGG $2,000,000 $ OTHER: A AUTOMOBILE AUTOMOBILE LIABILITY PHPK2409057 5/2/2022 5/2/2023 COMBINED SINGLE LIMIT Ea accidant $1.000,000 X BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS ac BODILY INJURY (PerTY cidant) $ X HIRED X NON -OWNED ONLY AUTOS ONLY PROPERDAMAGE Per accidant $ A X I UMBRELLALIAB X OCCUR PHUB812980 5/2/2022 5/2/2023 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 EXCESS LIAR CLAIMS -MADE DED X RETENTION$ in nnn $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN MEWC338374 2/8/2022 2/8/2023 X I PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 ANYPROPRIETORIPARTNEWEXECUTIVE ❑ OFFICEWMEMBEREXCLUDED'1 N/A E.L. DISEASE -EA EMPLOYEd $1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONSb.l. E.L. DISEASE -POLICY LIMIT $1.000.000 A A Professional Liability D&OIEPLI PHPK2409057 PHSD1680830 5/2/2022 12/17/2021 5/2/2023 5/2/2023 Per OccunencelAggg Each Policy Pedotl $1000000/$2000000 3.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe 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 (10111) 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. IVE - ManlgeerIONisdwr Renwe06 APmw®av: %Pu PicxJerr IJ 1B88-ZU10 ACUKU Ct ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD