|
CITYNET-02 ASUGAHARA
<br /> CERTIFICATE OF LIABILITY INSURANCE DAT 6/1 812 1812DlYYYYJ
<br /> 025
<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 endorsements.
<br /> PRODUCER License#0757776 CONTACT Amy Sugahara
<br /> NAME:
<br /> HUB International Insurance Services Inc. PHONE a,Ext):(442)244 6917 FAX
<br /> No
<br /> 1525 Faraday Avenue )'
<br /> Suite 150 AbDARIE55,amy.sugahara@hubinternational.com
<br /> Carlsbad,CA 92008
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Philadelphia Indemnity.Insurance Company 18058
<br /> INSURED INSURER B:Berkshire Hathaway Homestate Insurance Company 20044
<br /> Kingdom Causes,Inc.dba City Net
<br /> 4508 Atlantic Ave INSURER C
<br /> Suite 292 INSURER D:
<br /> Long Beach,CA 90807--1520 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.OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> CLAIMS-MADE X OCCUR PHPK2663022-015 3/16/2025 3/112026 DAMAGE TO RENT CED 100,000
<br /> PREMI E Ea Currene $
<br /> MEO EXP(Any oneperson) $ 5,000
<br /> PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY PECOT- ❑ LOC PRODUCTS-COMPIOPAGG $ 4,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> ANY AUTO PHPK2708361-000 3/1612025 3/1/2026 BODILY INJURY Per erson $
<br /> OWNED 1xx
<br /> SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> AUTOS ONLY NON-OWNED
<br /> ONLY P?accidentDAMAGE $
<br /> A X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000
<br /> EXCESS LIAB CLAIMS-MADE PHUB903241-005 3/16/2025 3/112026 AGGREGATE $ 5,000,000
<br /> ❑E❑ I X RETENTION$ 10,064
<br /> B WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY y,I N TATUTE ER
<br /> ANY PROPRIETORIPARTNERJEXECUTIVE a NIA KIWCfi25771 3/112025 3Hf2026 1,aaa,000
<br /> OFFICERMEMBER EXCLUDE D7 E.L.EACH ACCIOENT $
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000
<br /> If yes,describe under 11000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT
<br /> A Misconduct/Abuse PHPK2663022-015 3/1612025 31112626 See Below for Limits
<br /> A Professional Liab PHPK2663022-015 311//2025 31112026 See Below for Limits
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> Umbrella Liability applies to General Liability,Employers Liability,Professional Liability and Abuse and Misconduct Liability Only
<br /> City of Santa Ana,its City Council,its officers,officials,employees,agents,and volunteers are included as an Additional Insured with respects to the above
<br /> captioned general liability policy where required by written contract.A Waiver of Subrogation also applies to the above captioned general liability policy
<br /> where required by written contract. TU Tran TuTral�yNquy ey
<br /> Professional Liability I Occurrence Form 1$1,000,000 Each Occurrence 1$2,000,000 Aggregate I No Deductible Date:2025.06. e
<br /> Abuse&Misconduct Liability I Occurrence Form I$1,000,000 Each Occurrence I$1,000,000 Aggregate I No Deductible Nguyen 120659-07-0
<br /> SEE ATTACHED ACORD 101
<br /> CERTIFICATE HOLDER CANCELLATION 4 APPROVED
<br /> gy To Tran Nguyen at 12:06 pm;Jun f8,2025
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana-Substance Abuse Treatment Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attention:Executive Director
<br /> Community Development Agency
<br /> 20 Civic Center Plaza M-30 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana,CA 92701
<br /> ACORD 25(2016103) Cc71988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
|