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ACORO® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDA'YYY)
<br />1
<br />1114.,/
<br />03/07/2024
<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 pollcy(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 certif ate hplder in lieu,of such ep4orsemilinI
<br />D
<br />rbin
<br />n I II rte vices
<br />Acevedo
<br />PH(650) 412-7542 F (650) 488-8566
<br />C IN Ext: AIC. No:
<br />777 Marine land Blvd.
<br />f!—'f15
<br />E-MAIL pauline.durbin@newfmnt.wm
<br />ADDRESS:
<br />ite 250 Date: 2024.03
<br />ERB AFFORDING COVERAGE
<br />NAIC#
<br />INSURERA: Nonprofits' Insurance Alliance
<br />CA P4404
<br />ateextedo
<br />INS E
<br />INSURER B : State Comp. Ins. Fund
<br />35076
<br />Asian American Senior Citizens Service Center, Inc
<br />INSURER C : Underwriters at Lloyd's, London
<br />0000
<br />850 North Birch Street
<br />INSURER O:
<br />NSURERE:
<br />Santa Ana CA 92701
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: CL2310156951 REVISION NtINI
<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 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />BUSH
<br />Me
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDhNYY)
<br />POLICY EXP
<br />IMMfDDA`YYYI
<br />LIMITS
<br />x
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ® OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PREMISES Ea occurrence
<br />$ 500,000
<br />MED EXP Any one person)
<br />$ 20,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />Y
<br />2023-01391
<br />06/05/2023
<br />06/05/2024
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />POLICY ❑ JECPRO❑
<br />ECT LOC
<br />GENERALAGGREGATE
<br />$ 3,000,000
<br />PRODUCTS - COMPIOPAGG
<br />$ 3,000,000
<br />$
<br />OTHER
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident)
<br />$ 1.000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />2023-01391
<br />06/05/2023
<br />06/0512024
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident)
<br />$
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />OEO
<br />I I RETENTION $
<br />S
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITYYIN
<br />ANY PROPRIETORIPARTNEWEXECUTIVE ❑
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />DESCRIPTION antler
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />Y
<br />9100741-23
<br />10/0112023
<br />10/01/2024
<br />X PER OTH-
<br />STATUTE I I ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000.000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />Cyber Liability
<br />ESM0139762497
<br />09/01/2023
<br />09/01/2024
<br />Limit
<br />Ded.:
<br />$1,000,000
<br />$2,500
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Insr Ltr:A: Sexual Conduct Liability coverage; Policy #2023-01391; Policy Eff. dates: 06105/2023-06/05/2024; Limit: Each Claim: $1,000,000; Aggregate:
<br />$1,000,000
<br />Insr Ltr:A: Social Services Professional Liability; Policy #2023-01391; Policy Eff. dates: 06/05/2023-06/05/2024: Each Event: $1,000,000: Each Aggregate:
<br />$2,000,000
<br />City of Santa Ana is included as additional insured on General liability policy per the attached form. General liability Coverage is primary and non-contributory
<br />per the attached form. Waiver of Subrogation applies to General Liability and Worker's Compensation policies per the attached forms
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana,
<br />CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PRO'
<br />o❑
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<br />Risk Man#ganadDividan
<br />ReAEWED&APPRrH®BY:
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<br />Risk Management Specialist
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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