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Southern California ReLiEF CERTIFICATE OF COVERAGE <br />Issue Date <br />7/1/2024 <br />Protected Insurance Program for Schools <br />ADMINISTRATOR: LICENSE # 0451271 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY <br />Keenan & Associates AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />901 Calle Amanecer, #2OO CERTIFY ,ATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE <br />San Clemente, CA 9267 AFFOR IED BY THE COVERAGE D UMENTS BELOW. <br />ENTIT ES A O �I <br />s I n e <br />1 <br />- 6 1 y <br />Sophia Canez Llamas Licen . 4R9tySIA <br />sllcmas@keenan.com ENTIT ,: South Callfornla'ReLIEF <br />COVERED PARTY: ENTIT` "byte�nnig¢ e[og f�Vc!Pd O <br />North Orange County <br />uYY „` 1 I C C V C <br />.O.P. <br />Northern Orange County Liability & PENTI (C. <br />385 N. Muller Street EN FYD: <br />A OA 4.�7.Anaheim CA 92801L] <br />15 <br />L]F �TITY E: <br />THIS IS TO CERTIFY THAT THE C ES STED HE C _,ate: <br />NAMED ABOVE FOR i PE PERIOD INDICATED. TWITHST9NDING ANY <br />REQUIREMENT, TERM ORCOND ONO ONT TOR OT DO MENT H R 'C HI E� IC �fl" SUED AY HE COVERAGE <br />AFFORDED HEREIN IS SUBJECT O ALL E A DITI S OF O DO. <br />MEMBER <br />ENT COVERAGE I EFFECTIVE/ RETAINED LIMIT <br />TYPE OF COVERAGE LIMITS <br />LTR DOCUMENTS EXPIRATION DATE / DEDUCTIBLE <br />A <br />GENERAL LIABILITY <br />COMBINED SINGLE LIMIT EACH OCCURRENCE <br />[ �J GENERAL LIABILITY <br />[ ], CLAIMS MADE [OCCURRENCE <br />SCR 00104-38 <br />7/1/2024 <br />$ 25,000 <br />$ 1,000,000 <br />GOVERNMENT CODES <br />7/1/2025 <br />[ ERRORS & OMISSIONS <br />[ SEXUAL ABUSE AND MOLESTATION <br />A <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT EACH OCCURRENCE <br />[ ANY AUTO <br />SCR 00104-38 <br />7/1/2024 <br />$ 25,000 <br />$ 1,000,000 <br />[ HIRED AUTO <br />7/1/2025 <br />[ NON -OWNED AUTO <br />[ GARAGE LIABILITY <br />[ AUTO PHYSICAL DAMAGE <br />A <br />PROPERTY <br />SCR 00104-38 <br />7/1/2024 <br />$ 25,000 <br />$ 500,250,000 <br />[ ALL RISK <br />7/1/2025 <br />EACH OCCURRENCE <br />[ EXCLUDES EARTHQUAKE & FLOOD <br />[ ] BUILDER'S RISK <br />A <br />STUDENT PROFESSIONAL LIABILITY <br />SCR 00104-38 <br />7/1/2024 <br />$ 25,000 <br />$ Included <br />7/1/2025 <br />EACH OCCURRENCE <br />B <br />WORKERS COMPENSATION <br />[ ] WC STATUTORY LIMITS [ OTHER <br />[ �J EMPLOYERS' LIABILITY <br />PIPS12821 <br />7/1/2024 <br />$ <br />7/1/2025 <br />$ 1,000,000 <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />EXCESS WORKERS COMPENSATION <br />[ ] EMPLOYERS' LIABILITY <br />$ <br />E.L. DISEASE - EACH EMPLOYEE <br />$ 1,000,000 <br />E.L. DISEASE - POLICY LIMITS <br />OTHER <br />$ <br />$ <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL PROVISIONS: <br />As respects to the Subaward Agreement for Workforce Training by and between the City of Santa Ana and North Orange County Regional Occupational <br />Program identified by the assigned Unique Entity Identifier Number Y42HCM26UKN1. <br />$2,000,000 annual aggregate, as required by contract. <br />CERTIFICATE HOLDER: <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana <br />THE EXPIRATION DATE THEREOF, NOTICE' <br />P.O. Box 1988 (M-76) <br />ACCORDANCE WITH THE POLICY PROVISI( °^, F RAMamgementDims[c <br />20 Civic Center Plaza (M-30) <br />aF REVIEWED&APPROVED B <br />Santa Ana CA 92702-1988 <br />( A-pLe A auc� <br />&iskManagement Speciali <br />John Stephens AUTHORIZED REPRESENTATIVE <br />�I <br />Ce sOniNe Qom <br />20727662 1 NORTHORAI 124/25 Super Pool P&L I Sophia Canez Llamas 17/1/2024 1:42:57 PM (PDT) I Page 1 of 3 <br />