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DATE(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE 9/26/2024
<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
<br /> NAME: Brandon Fujii
<br /> CalNonprofits Insurance Services PHONE FAX
<br /> 150041stAvenue, Suite228 A/C No EXt: 831-824-5020 A/c,No:831-462-8529
<br /> Capitola CA 95010 ADDE-MRESS: brandon@cal-insurance.org
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: Philadelphia Indemnity Insurance Company 18058
<br /> INSURED OCHUMAN-01 INSURERB: Underwriters at Lloyds, London
<br /> OC Human Relations Council INSURERC: Hartford Casualty Insurance Company 29424
<br /> dba: Groundswell
<br /> 1801 E Edinger Ave, Ste. 115 INSURERD:
<br /> Santa Ana CA 92705 INSURERE:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1006107115 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICYNUMBER MM/DD MM/DD
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y PHPK2664706 4/26/2024 4/26/2025 EACH OCCURRENCE $1,000,000
<br /> DAMAGES( RENTED
<br /> CLAIMS-MADE OCCUR
<br /> PREMISES Ea Occurrence)
<br /> ccurrence) $100,000
<br /> MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY❑ PRO ❑
<br /> JECT LOC PRODUCTS-COMP/OP AGG $1,000,000
<br /> X
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY PHPK2664706 4/26/2024 4/26/2025 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 /> A X UMBRELLA LAB X OCCUR PHUB903790 4/26/2024 4/26/2025 EACH OCCURRENCE $2,000,000
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $2,000,000
<br /> DED RETENTION$ $
<br /> C WORKERS COMPENSATION 57WECAN1ML1 10/1/2024 10/1/2025 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? FN] N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> A Professional Liability PHPK2664706 4/26/2024 4/26/2025 Each Occ./Aggregate $1M/$2M
<br /> B Cyber Liability ESM0139833965 12/15/2023 12/15/2024 Policy Aggregate $1,000,000
<br /> A Sexual Abuse and Molestation PHPK2664706 4/26/2024 4/26/2025 Per Claim/Aggregate $1M/$2M
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> Employee Theft: Limit$100,000 Per Occurrence, Deductible$1,000; Philadelphia Indemnity Insurance Company, policy#PHPK2664706,eff Date 4/26/2024 to
<br /> 4/26/2025.
<br /> Business Personal Property: Limit$70,000, Deductible$1,000; Special Form, Replacement Cost,90%Coinsurance; Philadelphia Indemnity Insurance
<br /> Company,policy#PHPK2664706, Eff Date 4/26/2024 to 4/26/2025.
<br /> Director's and Officer's: Policy#:PHSD1 81 4880-01 2, Effective 07/30/2024 to 07/30/2025, Policy Aggregate Limit:$1,000,000
<br /> City of Santa Ana, its officers,officials,employees,and volunteers are included as Additional Insured with respect to General Liability as required by written
<br /> contract per Endorsement Form PI-GLD-HS attached. General Liability coverage is Primary& Non-contributory,per Endorsement Form PI-GL-005 attached.
<br /> Waiver of Subrogation applies as required by written contract per Endorsement Form PI-GLD-HS.
<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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> City of Santa Ana
<br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701 i
<br /> ACORD 25(2016103) The ACORD name and logo are registered n APPROVED
<br /> By Cynthia Mora at 3:27 pm, Nov 19, 2024
<br />
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