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<br />A� " CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />07/28/2025
<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
<br />CONTACT Lynne Arruda
<br />NAME: y
<br />Alera Group, Inc.
<br />PAHCNr o (508) 995-4553 FAAic, (508) 995-4525
<br />Ext : No):
<br />500 Faunce Corner Road
<br />E-MAIL lynne.arruda@aleragroup.com
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />Building 100, Suite 120
<br />INSURERA: Lexington/RTS
<br />Dartmouth MA 02747
<br />INSURED
<br />INSURER B : Coalition Insurance Solutions, Inc.
<br />FGP-02X Holding LLC
<br />INSURER C :
<br />1 Mill Wharf Plaza
<br />INSURER D :
<br />Unit S12
<br />INSURER E :
<br />Scituate MA 02066
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 24-2: 24-25 GL/PROF EXC 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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
<br />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MWDD/YYYY
<br />POLICY EXP
<br />MWDD/YYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X CLAIMS -MADE OCCUR
<br />DAMAGE TO RE
<br />PREMISES Ea occurrence
<br />$ 300,000
<br />X
<br />MED EXP (Any one person)
<br />$ 1,000,000
<br />Professional Liability
<br />X
<br />Ded$10,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />Y
<br />1070632
<br />09/19/2024
<br />01/01/2026
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />X POLICY ❑ PRO ❑ LOC
<br />JECT
<br />PRODUCTS-COMP/OPAGG
<br />$ 1,000,000
<br />Healthcare GLAgg
<br />$ 3,000,000
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Y
<br />Y
<br />1070632
<br />09/19/2024
<br />01/01/2026
<br />BODI LY I NJ U RY (Pe r accide nt)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED �/ NON -OWNED
<br />AUTOS ONLY X AUTOS ONLY
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X
<br />AGGREGATE
<br />$ 1,000,000
<br />A
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />6798924
<br />09/19/2024
<br />01/01/2026
<br />DED I I RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />PER OTH-
<br />STATUTE ER
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE ElN
<br />OFFICER/MEMBER EXCLUDED?
<br />/A
<br />E.L. EACH ACCIDENT
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />B
<br />Cyber Liability
<br />C-4LPL-107922-CYBER-2024
<br />11/17/2024
<br />01/01/2026
<br />Limit
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Abuse & Molestation - Policy # 1070632 eff 09/19/2024 - Coverage Limit: $1,000,000 Each Perpetrator / $2,000,000 Aggregate Digitally ign
<br />by Tu Tr n
<br />City of Santa Ana, its City Council, its officers, officials, employees, agents and volunteers are Additional Insureds with respects to General Liability and Tu Tran Nguyen
<br />Automobile Liability, on a primary and non-contributory basis including waiver of subrogation, as required by written contract only, per attached policy form. Nguyen Dat en e
<br />Policy includes 30 Day Notice of Cancellation. g y 2o2s.o9. 7
<br />Retro-active dates: Professional Liability 9/19/2021, General Liability 9/19/2018 08:24.46 071
<br />Employee Benefits Liability - Policy # 1070632 eff 09/19/2024 - Coverage Limit: $1,000,000 / $3,000,000
<br />APPROVED
<br />CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 8:24 am, Sep 17, 2025
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Santa Ana Police Dept
<br />AUTHORIZED REPRESENTATIVE
<br />60 Civic Center Plaza (M-18)
<br />Santa Ana CA 92701
<br />@ 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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