|
A�1 CERTIFICATE OF LIABILITY INSURANCE DAT4(MmiDD F
<br /> /312025YYY)
<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 /> Inszone Insurance Services, LLC NAME:
<br /> 2721 Citrus Road, Suite A PHONE E ,877-308-9663 FAX,-No:916-503-6271
<br /> Rancho Cordova CA 95742 ADDRESS: info@inszoneins.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> License#:OF82764 INSURER A:Nonprofits Insurance Alliance 10023
<br /> INSURED CENTFOR-04 INSURER B:Hartford Casualty Insurance Company 29424
<br /> Center for Applied Research Solutions(CARS)
<br /> 1275 4th Street,#190 INSURER C:Cowbell
<br /> Santa Rosa, CA 95404 INSURERD:Philadelphia Indemnity Insurance Company 18058
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1683550424 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 SUER POLICY EFF POLICY EXP
<br /> LTR POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y 2024-34220 9/10/2024 9/10/2025 EACH OCCURRENCE $1.000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE M OCCUR PREMISES Eaoccurrence $500,000
<br /> MED EXP(Any one person) $20.000
<br /> PERSONAL&ADV INJURY $1,000.000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000.000
<br /> POLICY PRO ❑
<br /> JECT LOG PRODUCTS-COMP/OPAGG $2.000,000
<br /> X
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY Y 2024-34220 9/10/2024 9/10/2025 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> 5
<br /> A X UMBRELLA LIAB X OCCUR 2024-34220-UMB 9/10/2024 9/10/2025 EACH OCCURRENCE $2,000,000
<br /> EXCESS LIAB CLAIMS-MADE I AGGREGATE $2,000,000
<br /> DED RETENTION$ 5
<br /> B WORKERS COMPENSATION Y 57MCDS7639 7/1/2024 7/1/2025 X SPER OT
<br /> TATUTE EERH
<br /> AND EMPLOYERS'LIABILITY Y/N
<br /> ANYPROPRIETORIPARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT 51,000,000
<br /> OFFICERIMEMB ER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT $1,000.000
<br /> C Cyber Liability FLY-CB-E9J95CULA-002 7/19/2024 7119/21 Aggregate $1,000,000
<br /> D Directors and Officers PHSD1855251-009 1/15/2025 1/15/2026 Aggregate/Each Claim $2,000,000
<br /> D Errors and Omissions PHSD1870689 4/16/2024 4/16/2025 Aggregate/Each Claim $2,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Liquor Liability-Policy#2024-34220-Effective Date 9/10/2024-Expiration Date 9110/2025-Aggregate/Each Common Cause:$1,000,000-Nonprofits
<br /> Insurance Alliance NAIC#10023
<br /> Improper Sexual Conduct&Physical Abuse Liability- Policy#2024-34220-Effective Date 9/10/2024-Expiration Date 9/10/2025-Aggregate/Each Common
<br /> Cause:$1,000,000-Nonprofits Insurance Alliance NAIC#10023
<br /> City of Santa Ana included as additional insured as regards to general liability.Waiver of subrogation applies for general liability,auto liability,and workers
<br /> compensation.
<br /> APPROVED
<br /> CERTIFICATE HOLDER By Tu Tran Nguyen at 8:05 am,Apr-14,2025 CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Digildly,i nedTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana Tu Tran N9uye ran ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Parks, Recreation, and Community ServiceNguyen 0eo 3425 4.14
<br /> 20 Civic Center Plaza, M-23 THORIZEDREPRESENTATIVE
<br /> Santa Ana CA 92701
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
|