|
DATE(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE 9/24/2025
<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 CONTACT
<br /> NAME:
<br /> (OC) Heffernan Insurance Brokers PHONE FAX
<br /> 18004 Sky Park Circle, Suite 210 A/C No Ext: 949-771-3400 vc,No:949-771-3401
<br /> E-MIrvine CA 92614 ADDRESS: hibcertrequest@heffins.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> License#:0564249 INSURERA: GuideOne Specialty Mutual Insurance Company 14559
<br /> INSURED HUMAOPT-04 INSURER B: GuideOne Mutual Insurance Company 15032
<br /> Human Options, Inc.
<br /> PO Box 53745 INsuRERc: Coalition Insurance Company 29530
<br /> Irvine CA 92619 INSURERD:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1404250430 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 POLICY NUMBER MM/DD MM/DD
<br /> B X COMMERCIAL GENERAL LIABILITY Y Y 01-0041-350 9/23/2025 9/23/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE OCCUR PREMISES DAMAGE TO
<br /> PREMISES Ea occurrence)
<br /> ccurrence $1,000,000
<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 El JECT
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY Y Y 01-0041-351 9/23/2025 9/23/2026 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 FIR ERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> A X UMBRELLALIAB X OCCUR 01-0041-352 9/23/2025 9/23/2026 EACH OCCURRENCE $5,000,000
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED X RETENTION$ $
<br /> A WORKERS COMPENSATION Y 01-0037-245 4/1/2025 4/1/2026 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICE R/M EMBER EXCLUDED? ❑ 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 /> B Professional Liability 01-0041-350 9/23/2025 9/23/2026 Per Claim Limit $1,000,000
<br /> B Sexual Misconduct 01-0041-350 9/23/2025 9/23/2026 Per Claim Limit: $1,000,000
<br /> C Cyber Liability C-50FL-050194-CYBER-2025 9/23/2025 9/23/2026 Each Claim Limit $1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Employee Theft Coverage included in Policy#01-0041-350 Limit:$500,000
<br /> Re:As Per Contract or Agreement on File with Insured.
<br /> City of Santa Ana,officers,agents,employees and volunteers are included as an additional insured(primary and non-contributory)on General Liability policy
<br /> and additional insured on Automobile Liability policy per the attached endorsements, if required.$5M Umbrella policy goes over the underlying General Liability,
<br /> Automobile Liability,Workers'Compensation,and Sexual Misconduct Policies.Waivers of Subrogation are included on General Liability,Automobile Liability
<br /> and Workers Compensation policies per the attached endorsements, if required.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Digitally signed THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana TU Tran byTuTran ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> CommunityDevelopment A enc Nguyen
<br /> p g y N g U ye n Date:2025.09.24
<br /> 20 Civic Center Plaza, M-25 16:06:00-07'00' AUTHORIZED REPRESENTATIVE
<br /> Santa Ana, CA 92701 f /
<br /> � G
<br /> / ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|