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AC ® DATE(MMIDD/YYYY)
<br /> �� CERTIFICATE OF LIABILITY INSURANCE 11/13/2023
<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
<br /> NAME:
<br /> (OC)Heffernan Insurance Brokers PHONE FAX
<br /> 18004 Sky Park Circle, Suite 210 fa/C.No.Extt:949-771-3400 We,No):949-771-3401
<br /> Irvine CA 92614 I E-MAIL DRESS:
<br /> D i �J�tf noel! n e�GE NAIL#
<br /> i
<br /> eicense#:056424) INSURER hl a e p In'noel! nsurance Company 18058
<br /> INSURED ORANCOU-0 I IN le �(a�altnna f�ty 0 aJ�(of America 31194
<br /> Orange County's United ay N c d Morn
<br /> ` V��V
<br /> 18012 Mitchell South
<br /> Irvine CA 92614-6008 ;DER
<br /> N u EC�IQ. `'1'20� .05�23
<br /> ' I- ,♦ _ INSURER F:
<br /> COVERAGES Mi«TEG:YILIMTV .1 1r a • . • A -jat!` 24 NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTrt r LOW HAVE! T, -- II IN R"tt ' Lr: ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM JP .JONDITION 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 LTR TYPE OF INSURANCE INSD SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> (MMIDDIYYYY) IMMIDD/YYYY]_
<br /> A X COMMERCIAL GENERAL LIABILITY Y PHPK2618575 11/1/2023 11/1/2024 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $1,00 0,000
<br /> MED EXP(Any one person) $20,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000
<br /> POLICY PRO LOC PRODUCTS-COMP/OP AGG $3,000,000
<br /> X PRO-
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY PHPK2618575 11/1/2023 11/1/2024 COMBINED SINGLE LIMIT $1,000,000
<br /> (Ea accident)
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> - OWNED ' SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS _
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY (Per accident)
<br /> $
<br /> A X UMBRELLALIAB X OCCUR PHUB887255 11/1/2023 11/1/2024 EACH OCCURRENCE $5,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED X RETENTION$1n jtn $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> OFFICERIMEMBEREXCLUDED? N IA
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A Professional Liability PHPK2618575 11/1/2023 11/1/2024 Occ$1MM/Agg 3,000,000
<br /> B Crime 107338302 11/1/2023 11/1/2026 Empl.Theft/Forgery 1,000,000
<br /> C Cyber Liability ESM0939800786 11/1/2023 11/1/2024 1st&3rdOcc$1MM/Agg 1,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Sexual Abuse and Molestation coverage-$1,000,000.
<br /> The$5M Umbrella policy extends over the General Liability.
<br /> Re:TBD(023);Consent of Assignment of Emergency Solutions Grant Subrecipient Agreement Between The City of Santa Ana and 211 Orange County;and
<br /> Acknowledgement of Assumption.City of Santa Ana,its officers,employees,agents and representatives are included as an additional insured(primary and
<br /> non-Contributory)on General Liability policy per the attached endorsements,if required.
<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 ACCORDANCE WITH THE POLICY PRC\
<br /> Risk Management Division, 4th floor .F.L.:&,,< Risk MaragzntattDiviston
<br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE REVIEU�ED&APPROVED BY:
<br /> Santa Ana, CA 92702 _ ¢41� d�a'A A AGA/a a
<br /> I ���
<br /> :�- Risk Management Specialist
<br /> ©1988-2015 ACORD/
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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