KAISER FOUNDATION HEALTH PLAN, INC.

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A� a CERTIFICATE OF LIABILITY INSURANCE DATE2024 yYY3 ovlvzoz4 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER MARSH RISK& INSURANCE SERVICES Digitally signedFA CAF(jrR {;y�L�CE 1 0 ANRASR1 0 1`�Vedo Acevedo CONTACT ' AlG No Ext: AIC No: EMAIL ADDRESS: kR(S) AFFORDING COVERAGE NAIC# Date: 2024.03.06 INSURER A: Safety Natonal Cwuafty Corp. 15105 CN101483686-SCAL-CAS-24-25 o'ALW CA INSURED KAISER FOUNDATION HEALTH PLAN, INC. INSURER B : INSURER C : KAISER FOUNDATION HOSPITALS 393 EAST WALNUT STREET PASADENA, CA 91188 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: SEA-003811693-07 REVISION NUMBER: 5 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR rypE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MMIDD UNITS A X COMMERCIAL GENERAL LIABILITY GL 4048017 01/01/2024 01/01/2025 EACH OCCURRENCE $ 5,000,000 CLAIMS -MADE Lx OCCUR TO VA TDAMAGPREMIES(RENTED PREMISES Ea occurrence) S 5,000,000 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 5,000,000 AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 5,000ODD GEN'L X POLICY ❑ PRO- ECT ❑ LOG PRODUCTS-COMPIOPAGG $ 5,000,000 $ OTHER: A AUrOMOBILELIABILITY CA6675880 01/01/2024 01/01/2025 COMBINED SINGLE LIMIT Ea accident It 4,000,000 A X ANY AUTO $1,000,000 SIR BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DIED RETENT $ I A WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN OFFCERJMEMB REXCLUDED?ECUTIVE (Mandatory in NH) NIA SP 4067916 S.I.R. $5,000,000ANY 01/012025 X PER OTH- GTATUTE ER E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPLOYEE g 5,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mare space is required) REQUEST#RCOD8772 THE CITY OF SANTA ANA, ITS OFFICERS, OFFICIALS, EMPLOYEES AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY TO THE EXTENT REQUIRED BY WRITTEN CONTRACT. THE GENERAL LIABILITY POUCY IS PRIMARY AND NON-CONTRIBUTORY WHERE REQUIRED BY WRITTEN CONTRACT. POLICIES INCLUDE WAIVER OF SUBROGATION WHERE REQUIRED BY WRITTEN CONTRACT AND ALLOWED BYLAW. HOLDER CITY OF SANTA ANA 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRC AUTHORIZED REPRESENTATIVE G ,y ., RMkMnmgastentDNMlnn NEvRMiEo/&APPRovm BY: ® Risk Managemen[Speualis[ ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD