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Digitally signed
<br />r r
<br />Jar r lar rir ra Uy 3011 lot I LI to IVI. URANCOU-C3
<br />TRYAN
<br />DATE(MMIODNYYY)
<br />1012312023
<br />ACORo CERTIFICAU. Q � NCE
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AN46)QMFFYGHTS 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 endorsemen s .
<br />PRODUCER
<br />Bolton Insurance Services LLC
<br />3475 E. Foothill Boulevard
<br />Suite 100
<br />Pasadena, CA 91107
<br />C TACT
<br />E
<br />PHONE FAX
<br />curc, Na, Exl : (626) 799-7000 (A/c, Na :(626) 441-3233
<br />ADDRE S:
<br />INSURER s AFFORDING COVERAGE
<br />NAIL e
<br />INSURER A:Philadelphia lndemni Insurance Company
<br />18058
<br />INSURED
<br />INSURER B: Republic Indemnity Company of America
<br />22179
<br />INSURER C:
<br />Orange County Educational Arts Academy
<br />INSURER D:
<br />825 N. Broadway
<br />Santa Ana, CA 92701
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER -
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVEBEEN ISSUEDTOTHE INSURED NAMED. ABOVE FORTHE POLICYPERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOROTHER DOCUMENTWITH RESPECTTOWHICH 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 />TYPE OF INSURANCE
<br />ADDLSUSR Nsn
<br />min
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPLTR YYNYI
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />PHPK2573308
<br />71112023
<br />7/1/2024
<br />EACH OCCURRENCE
<br />1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occuR
<br />300,000
<br />MED EXP An one anon
<br />15,000
<br />PERSONAL B ADV INJURY
<br />1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />X POLICY E JET F LOG
<br />GENERALAGGREGATE
<br />3,000,000
<br />PRODUCTS - COMP/OP AGO
<br />3,000,000
<br />OTHER:
<br />SEXUAL ABUSE
<br />1,000,000
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINEEa.d.D SINGLE LIMIT
<br />1,000,000
<br />BODILY INJURY Per son
<br />AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />PHPK2573308
<br />7/112023
<br />7/112024
<br />IxANY
<br />BODILY INJURY Per accident
<br />$
<br />P OPa Rryiit AMAGE
<br />AUTOS ONLY X AIOTIN'OS ONLB
<br />A
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />10,000,000
<br />AGGREGATE
<br />10,0001000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />PHUBB71207
<br />7/112023
<br />71112024
<br />DED X RETENTION$ 10,000
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETOWPARTNERIEXECUTNE
<br />FFICERIry,MEER) EXCLUDED?
<br />Mandstq
<br />H yes,d scribe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />25429204
<br />71112023
<br />711/2024
<br />V PERT E OTH-
<br />E.L EACH ACCIDENT
<br />1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />1,000,00D
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />A
<br />Sexual Misconduct
<br />PHPK2573308
<br />7/112023
<br />71112024
<br />ILimit
<br />1,000,000
<br />A
<br />Directors & Officers
<br />PHPK2573312
<br />7/1/2023
<br />71112024
<br />Included in ELL
<br />10,000,000
<br />DESCRIPTION OF OPERATIONS) LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />School Grant
<br />City of Santa Ana, its officers, employees, agents and volunteers are Included as additional insured with respects to General Liability per
<br />the attached
<br />PI-GLD-VS (05117) policy forth, only if required by written contractiagreement.
<br />This insurance is primary and all other Insurance is non-contributory.
<br />RkleMwgJnadDbidpA
<br />.s' REviexEc&ApmvEOBY:
<br />CERTIFICATE HOLDER
<br />CANCELLATION 0. lulltl ? San
<br />A
<br />® Risk Management Supervisor
<br />SHOULD ANY OF THE ABOVE DESCR
<br />CI of Santa Ana
<br />City
<br />Risk Management Division
<br />THE EXPIRATION DATE THEREO OF
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />HO.AA el
<br />ACORD 25 (2016/03) ©1988.2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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