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DATE(MM/DD/YYYY)
<br /> �® CERTIFICATE OF LIABILITY INSURANCE
<br /> 2/19/2025
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or 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 endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME: Rachael Orman
<br /> Arthur J. Gallagher Risk Management Services, LLC PHONE FAX
<br /> 500 N Brand Boulevard, Suite 100 A/C No EXt: 818-539-9422 A/C,No:818-539-1510
<br /> Glendale CA 91203 ADDRESS: Rachael_Orman@ajg.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> License#:OD69293 INSURERA: Underwriters at Lloyd's London 15792
<br /> INSURED SOUTCAL-64 INSURERB: Indian Harbor Insurance Company 36940
<br /> Southern California Education Corporation dba
<br /> Southern California Institute of Technology INsuRERc:Western World Insurance Company 13196
<br /> 525 N Muller St INSURERD: Nautilus Insurance Company 17370
<br /> Anaheim CA 92801 INSURER E: Employers Preferred Insurance Company 10346
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1659256183 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR I POLICY NUMBER MM/DD/YYYY MM/DDIYYYY
<br /> C X COMMERCIAL GENERAL LIABILITY Y Y NPP8883049 1/15/2025 1/15/2026 EACH OCCURRENCE $2,000,000
<br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED
<br /> PREMISES Ea occurrence $100,000
<br /> MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000
<br /> POLICY PRO LOC PRODUCTS-COMP/OP AGG $Included
<br /> X JECT
<br /> OTHER:El $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
<br /> Ea accident
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> D UMBRELLALIAB X OCCUR AN1336575 1/15/2025 1/15/2026 EACH OCCURRENCE $5,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED RETENTION$ $
<br /> E WORKERS COMPENSATION EIG514875402 1/1/2025 1/1/2026 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN y STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> ❑
<br /> OFFICER/MEMBER EXCLUDED? N I A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> A Cyber Liability ESN0340227555 1/15/2025 1/15/2026 Limit $1,000,000
<br /> B Educator Legal Liability ELL09516107 1/15/2025 1/15/2026 See Below See Below
<br /> Employment Practices Liability
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more s APPROVED
<br /> ELL/EPL Limits:
<br /> Limit:$1,000,000/Aggregate:$1,000,000/Retention:$25,000 By Tu Tran Nguyen at 10:27 am, Feb 20, 2025
<br /> The Entity, its officers,officials,employees,and volunteers are named additional insured with respect to the operations of the named insured.Such insurance is
<br /> Primary and Non-Contributory.Waiver of Subrogation on General Liability applies in favor of Additional insured.Written notice shall be provided at least ten(10)
<br /> days in advance of cancellation for non-payment of premium and thirty(30)days in advance for any other cancellation or policy change.
<br /> Digitallysignedb
<br /> Tu Tran
<br /> Tu Tran Nguyen
<br /> Date:2025.02.20
<br /> CERTIFICATE HOLDER CANCELLATION Nguyen 10:2r.51-08o0
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> ATTN:Audrey Goodson
<br /> 801 W. Civic Center Dr., Suite 200 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701
<br /> @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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