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AoCil CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/VYYY) 16.� 1 12/21/2022 IS CERTIFICATE D AS A MATTER OF INFORMATION ONLY AND CONFERS G S UPON THE CERFIFIGATE HOLDER.S 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(les) 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 Hlscox Inc. dlblal Hlscox Insurance Agency In CA-NAME: 520 Madison AvenueE-MAILIke. 32nd Floor CONTACT PHONE (ggg) 202-3007 FAX No: No EXI AGoRESS: contact@hiscox.com INSURERS AFFORDING COVERAGE NAIC# New York, New York 10022 INSURERA: Hlscox Insurance Company Inc 10200 INSURED Hierarch Academy LLC DBA Jason Lee DBA Jason Lee 1717 Old Tustin Ave Suite B INSURER B INSURER C Santa Ana, CA 92705 INSURER 0: 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. ILYR TYPE OF INSURANCE ADDLSUBR POLICYNUMBER POLICY EFF MMIDDIYYVY POLICY EXP MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO R7NT7IT_ PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL S ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- ❑ ECT LOG GENERAL AGGREGATE $ PRODUCTS - COMPIOP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS H (Par accident) ( BODILY INJURY P$ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE per sccid.rd $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ H AGGREGATE $ EXCESS LIAB CLAIMS -MADE OED I RETENTION $ WORKERS COMPENSATION IPER OTH- AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMB ER EXCLUDED? NIA STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE. EA EMPLOYEE $ (Mandatory, In NH) If yes, describe under E.L. DISEASE -POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS below A Professional Liability Y Y P100.048.788.4 01/17/2023 01/17/2024 Each Claim:$ 250,000 A9ereaale: IS 260.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD let, Additional Remarks Schedule, may be attached If more space is required) The City of Santa Ana, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Contractor including materials, parts, or equipment furnished in connection with such work or operation s. City of Santa Ana 801 W. Civic Center Dr., Suite 200 Santa Ana, CA 92701 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 IININ916L10111 ZTA rd,I�e�feRfSi$ ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD