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DATE(MM/DD/VYVY)
<br /> AC®RDI CERTIFICATE OF LIABILITY INSURANCE
<br /> ki..../ 05/15/2024
<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 policy(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 certificate holder in lieu of such endorsement(s).
<br /> PRODUCER 'CONTACT Certificate Issuance Team
<br /> NAME:
<br /> Comprehensive Insurance Services P 0� FAX
<br /> r (alc,No):
<br /> 26429 Rancho Parkway South E jir t e orrtprigNti,C e.com
<br /> ngie ADDRES
<br /> Suite 120
<br /> I (S) FO I C V q NAIC#
<br /> Lake Forest CA 92630 NAira/tL I� 10023
<br /> INSURED IN -ER B State Compensation Insurance Fund 35076
<br /> Orange County Childr Therapeutic Arts Center IN14
<br /> rtia: 2®2�,.®5 a V
<br /> 2215 N.Broadway ceINSURER D:
<br /> �/e OINS11R2e.:19:27 -07'00'
<br /> Santa Ana CA d27.6 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: All 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 /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR ANSD SWVDR POLICY NUMBER POLICYEFF POLICY EXP LIMITS
<br /> TYPE OF INSURANCE (MMIDD/YYYYI (MMIDDlYYVYI
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE T $ 1,000,000
<br /> RENTED
<br /> CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 500,000
<br /> MED EXP(Any one person) $ 20,000
<br /> A Y Y 2023-09201 12/21/2023 12/21/2024 PERSONAL&ADV INJURY $ 1,000,000
<br /> GENII AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000
<br /> POLICY JECT PRO I xl LOC PRODUCTS-COMP/OP AGG $ 3,D00,000
<br /> OTHER: $0 Deductible $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> ANYAUTO BODILY INJURY(Per person) $
<br /> A - OWNED SCHEDULED 2023-09201 12/21/2023 12/21/2024 BODILYINJURY(Peraccident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> X AUTOS ONLY X AUTOS ONLY (Per accident)
<br /> $0 Deductible $
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
<br /> A - EXCESS LIAB CLAIMS MADE 2023-09201 12/21/2023 12/21/2024 AGGREGATE $ 1,000,000
<br /> DED I RETENTION$ $
<br /> WORKERS COMPENSATION XI STATUTE L 0RH $0 Deductible
<br /> AND EMPLOYERS'LIABILITY Y/N 1,000,OOD
<br /> B ANY PROPRIETOR/PARTNER/EXECUTIVE N N 1 A 9255171-24 06/05/2024 06/05/2025 E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> $1,000,000/1,000,000 Aggregate/Occurr
<br /> SocA Improperrol Sery Sexualice Conduct Liability 2023-09201 12/21/2023 12/21/2024 $3,000,000/1,000,000 A re ate/Occurr
<br /> Conduct Liability gg g
<br /> $0 Deductible
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/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 included as Additional Insured per attached endorsement CG2026. With respect
<br /> to claims arising out of the operations and uses performed by or on behalf of the named insured,such insurance as is afforded by this policy is primary and
<br /> is not additional to or contributing with any other insurance carried by or for the benefit of The City of Santa Ana,its officers,officials,employees,and
<br /> volunteers per attached endorsement NIAC E61. 30 day notice of cancellation with 10 day notice of cancellation for non-payment of premium per policy
<br /> provision. See attached forms list. Waiver of Subrogation applies per attached endorsement NIAC E26.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF,NOT)(E um I RF nFt IVFRFR Nd
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PRO,\
<br /> o'2..,�ec Risk Mating[me t Division
<br /> Risk Management Division REVIEWED&APPROVED BY:
<br /> AUTHORIZED REPRESENTATIVE o z
<br /> 20 Civic Center Plaza iI. i.)' Ap A
<br /> Santa Ana CA 92702 ;�'I..
<br /> 1 '-��' Risk Management Specialist
<br /> ©1988-2015 ACOF/ _ 4\
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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