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ONE0000-01 KDOHMAN <br /> ACORO CERTIFICATE OF LIABILITY INSURANCE DAT DIYYYY) <br /> 3/141214/2025 <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 License#0757776 CONTACT Stephanie Lanzas <br /> NAME: _ <br /> HUB International Insurance Services Inc. PHONru,Exq:(951 779-8562 FAX - <br /> PO Box 5345 ) (AIC,No): <br /> Riverside,CA 92517 aoMORIEss:stephanie.lanzas@hubinternational.com <br /> INSURER(S)AFFORDING COVERAGE NAIC#_ <br /> INSURER A:Philadelphia Indemnity Insurance CornDanv 18058 _ <br /> INSURED INSURER B: <br /> OneCIC INSURER C: <br /> 1901 E.Fourth Street,Suite 100 INSURERD: <br /> Santa Ana,CA 92705 <br /> INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 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 NUMBER POLICY EFF POLICY EXP <br /> D DDfYY`YYl IMMIDDrMYI LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE X OCCUR PHPK2631419-009 1/15/2025 1/15/2026 PREMISES DAMAGE TORENTED 100,000 <br /> ____ X X PREMISES Ea occurrence $ <br /> MED EXP(Any oneperson) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 <br /> X POLICY PRO- LOC PRODUCTS-COMP/OP AGG $ 3,000,000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 <br /> Ea accidenl�_ $ _ <br /> ANY AUTO X PHPK2631419-009 1/15/2025 1/1512026 BODILY INJURYLPerperson) $ <br /> OWNED X SCHEDULED -- - <br /> AUTOS ONLY AUTOS BODILY INJURY Per accident <br /> X HIRED X NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY Per accident $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE S_ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE S <br /> DED RETENTION$ S <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY YIN STATUTE I I ER_ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT S <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE S <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I $ <br /> q Abusive Conduct PHPK2631419-009 1/1512625 1/15/2026 Each Cond:$1M;Agg: 2,000,000 <br /> Digitally sign <br /> Tu Tra n byT.T­ <br /> Nguyen <br /> Nguyen y <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) N U DMe:2025.04 23 <br /> RE:GREEN MPNA and Orange County Environmental Justice Education Fund(OCEJ) 10:51:47 oso <br /> City of Santa Ana,its City Council,its officers,officials,employees,agents,and volunteers are Additional Insured with regard to General Liability when <br /> required by written contract per the attached endorsement form,attached-Waiver of Subrogation applies. <br /> Notice of Cancellation will be provided in accordance with policy provisions attached. APPROVED <br /> By Tu Tran Nguyen at 10:51 am,Apr 23,2025 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> y ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Risk Management Division <br /> 20 Civic Center Plaza <br /> Santa Ana,CA 92701 AUTHORIZEDD REPRESENTATIVE <br /> �i�d�t:c(Gf:d.Grd L. <br /> ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />