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EXHIBIT J
<br />AC40J?b CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(1^/YV)
<br />11/2112D/1/2022
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s).
<br />PRODUCER
<br />Comprehensive Insurance Services
<br />26429 Rancho Parkway South
<br />Suite 120
<br />Lake Forest CA 92630
<br />CONTACT Certifficate Issuance Team
<br />NAME:
<br />a�Nrio Ext: (949) 709-8800 plc, No
<br />AODREss: leremy@lhecomprehensiveinsurance.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC N
<br />INSURERA: Nonprofits Insurance At [lance of California
<br />10023
<br />INSURED
<br />Orange County Children's Therapeutic Arts Center
<br />2215 N. Broadway
<br />Santa Ana CA 92706
<br />INSURER B: State Compensation Insurance Fund
<br />35076
<br />INSURER C:
<br />INSURER D:
<br />INSURER E:
<br />1 INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: All REVISION NUMBER:
<br />THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ILTR
<br />TYPE OF INSURANCE
<br />IN80
<br />MO
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDf EFF
<br />C XP
<br />POLICY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE Fx� OCCUR
<br />MAGE TO RMI
<br />PREMISES Eaoccurrence
<br />$ 500,000
<br />MED EXP(Anyone person)
<br />$ 20,000
<br />A
<br />Y
<br />Y
<br />2022-09201
<br />12121/2022
<br />12/21/2023
<br />PERSONAL&ADV INJURY
<br />$ 1,000,DOO
<br />GENY. AGGREGATE LIMITAPPLIES PER:
<br />POLICY JECOT FX-1 LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />PRODUCTS - COMPIOPAGG
<br />$ 3,000,000
<br />$0 Deductible
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 11000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANVAUTO
<br />A
<br />OWNED F7 SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON -OWNED
<br />X AUTOS ONLY X AUTOS ONLY
<br />2022-09201
<br />12/21/2022
<br />12/21/2023
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$O Deductible
<br />$
<br />X
<br />UMBREL"LIAB
<br />X
<br />OCCUR
<br />EACHOCCURRENCE
<br />$ 1,000,000
<br />A
<br />EXCESS LIPS
<br />CLAIMS -MADE
<br />2022-09201-UMB
<br />12/21/2022
<br />12121/2023
<br />AGGREGATE
<br />$ 1,000,000
<br />DIED
<br />RETENTION $ 10000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANVPROPRIETORIPARTNDED? CUTIVE
<br />OFFICEIBMEMBN) EXCLUDED?
<br />(fyes,doryln NH)
<br />NIA
<br />9255171-22
<br />06/05/2022
<br />06/06/2023
<br />v OTH
<br />X PER
<br />$O Deductible
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE -EAEMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,ODO
<br />Dyes,RIPTION antler
<br />DESCRIPTION OF OPERATIONS below
<br />$1,000,000/1,000,000
<br />Aggregate/Occurr
<br />A
<br />Improper Sexual Conduct Liability Social Service Professional Liability
<br />2022-09201
<br />12/21/2022
<br />12/21/2023
<br />$2,000,000/1,OOD,000
<br />Aggregate/Occurr
<br />$0 Deductible
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD far, Additional Remarks Schedule, may be attached If more space Is required)
<br />The City of Santa Ana, Its officers, officials, employees, and volunteers are included as Additional Insured per attached endorsement CG2026. With respect
<br />to claims arising out of the operations and uses performed by or on behalf of the named Insured, such insurance as is afforded by this policy is primary and
<br />Is not additional to or contributing with any other insurance carried by or for the benefit of The City of Santa Ana, Its officers, officials, employees, and
<br />volunteers per attached endorsement NIAC E61. 30 day notice of cancellation with 10 day notice of cancellation for non-payment of premium per policy
<br />provision. See attached forms list. Waiver of Subrogation applies per attached endorsement NIAC E26.
<br />QFRTIFIQATF wni nFR CANCELLATION
<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
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702
<br />J
<br />v
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