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ACC)Ro® CERTIFICATE OF LIABILITY INSURANCE
<br />Ike
<br />DATE(MMIDDIYYYY)
<br />03/0112024
<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(tes) 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 endorsements .
<br />PRODUCER
<br />CgMEACT Lindsay Bosshart
<br />PNONE 949-381-7712 AX I1918
<br />Dickerson Insurance Services an Alera Group Company
<br />Riverside Drive, Los Angeles, CA 90039
<br />ADDRIEss: Lindsay.Bosshait@aleragroup.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />License #OM29112
<br />INSURER A: PHILADELPHIA INDEMNITY INSURANCE CO.
<br />18058
<br />INSURED
<br />INSURER B: SERVICE AMERICAN INDEMNITY COMPANY
<br />39152
<br />INSURER C:
<br />Charitable Ventures of Orange County
<br />INSURER D:
<br />1505 E. 17th Street, Suite 101
<br />Santa Ana, CA 92705
<br />INSURER E:
<br />NSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 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 />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />TR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />NUMBER
<br />POLICPOLICY
<br />MMIDDYEFF IYYYY
<br />MMIDD�
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />71 CLAIMS -MADE ®OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO ur
<br />RENT nPREMISES
<br />PREMISES doccerve
<br />$ 100,000
<br />MED EXP(Any one person)
<br />$ 6,000
<br />Abuse & Molestation (A&M)
<br />Professional Liability(Prof. Liab)
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />A
<br />X
<br />Y
<br />PHPK2553335
<br />07/1512023
<br />07/16/2024
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑ JECT LOG
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GENT
<br />PRODUCTS - COMPIOPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea extent)
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Y
<br />PHPK2553335
<br />07/15/2023
<br />07115/2024
<br />BODILY INJURV(Peraccitlent)
<br />$
<br />HIRED Ni
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Pe ai t
<br />$
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />$ 4,000,000
<br />A
<br />I EXCESS LIAR
<br />CLAIMS -MADE
<br />Y
<br />PHUB863811
<br />07/15/2023
<br />07/15/2024
<br />DED X1 RETENTION$ 10,000
<br />A&M and Prof. Liab.
<br />$ Included
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y
<br />EXCLUDED ANY ECUTIVE �
<br />OFFICER/MEMBER/
<br />(Mandatory in NH)
<br />NIA
<br />SATIS0511001
<br />07/15/2023
<br />07/15/2024
<br />X1 PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />DEsdescribe under
<br />S6RIPTION OF OPERATIONS belay
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />PROFESSIONAL LIABILITY
<br />A
<br />Y
<br />PHPK2302279
<br />07/15/2023
<br />07/15/2024
<br />EACH LIMIT
<br />$1,000,00
<br />AGGREGATE LIMIT
<br />$2,000,00
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />The City of Santa Ana, its officers, officials, employees, and volunteers are recognized as additional insured with respect to the operations for the name
<br />Insured subject to policy terms and conditions. Waiver of Subrogation on General Liability policy as required by Agreement. Waiver of Subrogatlon on Worker's
<br />Compensation policy as required by Agreement.
<br />Evidence only as respects to Workers Compensation.
<br />CERTIFICATE HOLDER 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 />Lindsay Bosshart
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />0"4 'e cs �a1.�f1.6^I CA
<br />© 1988-2016 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD
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