HALCYON BEHAVIORAL ADMINISTRATORS (HALCYON BEHAVIORAL, LLC)

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ACC> CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/27/2023 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 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 NAMECT Locl tcn Affinity, LLC PHONE 1 • • FAX • Lockton Affinity, LLC A/C No EM:800 278-INC 7 9 E-MAIL P. O. BOX 879610 I ADDRESS: _ Kansas City, MO 64187-961 �SURER(S)AFFORDING COVERAGE NAIC# w • w INSURED INSURER B : Hartf =c %cLJ.M.d nd it 7 SIMPLETHERAPY INC. HALCYON BEHAVI , LLC INSURER C 1080 W Shaw Ave. Ste 105 INSURE Fresno, CA 93711 INSURE Ddle: ZI)Z UR COVERAGES AMEMISICATIOMMES 0 DEVIBION hMJMBER: THIS IS TO CERTIFY THAT THEROLICIA 01%WFNAWLISIMBELIkW1111XV IS31iiWO TH I S M OFi- P IC I INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION r,r A'.f CONTRACT OR I� I!T TH ESP W S CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORCcD ',t THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVL '.cEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MWDD/YW POLICY EXP MWDD/YW LIMITS A X COMMERCIAL GENERAL LIABILITY X X 57SBAAY4GNC 01/01/2024 01/01/2025 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR X DAMAGE TO RENTED PREMISES Ea occurrence $ 1, 000 , 000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1, 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 , 000 , 000 POLICY PRO Fx1 LOC PRODUCTS - COMP/OP AGG $ 2 , 000 , 000 $ OTHER: A AUTOMOBILE LIABILITY X X 57SBAAY4GNC 01/01/2024 01/01/2025 COMBINED SINGLE LIMIT Ea accident $ 1 000 000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ X NON -OWNED HIRED AUTOS AUTOS A X UMBRELLA LIAB X OCCUR X X 57SBAAY4GNC Ol/Ol/2024 Ol/Ol/2025 EACH OCCURRENCE $ 6, 000, 000 AGGREGATE $ 6, 000, 000 EXCESS LIAB CLAIMS -MADE DED FT RETENTION $ SIR $ 10 000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N X 37WECAF7PA9 01/01/2024 01/01/2025 X STATUTE EERPER H ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1 , 000,000 OFFICER/MEMBER EXCLUDED? ❑ N /A E.L. DISEASE - EA EMPLOYEd $ 1, 000 , 000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ 1 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana is included as an Additional Insured on a primary and non-contributory basis on the General, Auto and Umbrella liability policy as required by written contract. A Waiver of Subrogation applies to the City of Santa Ana with respest to the General, Auto, and Umbrella policy as required by written contract. CERTIFICATE HOLDER CANCELLATION 3027968 City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PRC 20 Civic Center Plaza �„_erz,��E RA MAugmumt DMsIcrn Santa Ana, CA 92702 AUTHORIEPRESENTATIV� ddEVIEWED&APPROVED BY. o Ag�z Aav44 ® Risk Management Specialist ©1988-2014 ACORD ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 47456420 3027968