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AC Roy CERTIFICATE OF LIABILITY INSURANCE pATE(MM1DDfYYYY)
<br /> 09/19/2025
<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 CONTNAME ACT Certificate Department
<br /> Newfront Insurance Services,LLC PHONE (415)754 3635 FA!Cx
<br /> No A
<br /> 777 Mariners Island Blvd E-,MAIL
<br /> ADRESS; certs@newfront.com
<br /> Suite 250 INSURERS AFFORDING COVERAGE NAIL
<br /> San Mateo CA 94404 INSURER A: Alliance of Nonprofits for Insurance,Risk Retention Group,Inc. 10023
<br /> INSURED INSURERB: State Compensation Insurance Fund 35076
<br /> Asian American Senior Citizens Service Center Inc(AASCSC) INSURER c: Underwriters at Lloyd's,London
<br /> INSURER D:
<br /> 850 North Birch Street INSURERE:
<br /> Santa Ana CA 92701 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 6F INSURANCE ADDLSUBR POLICY EFF POLICY EXP
<br /> LTR POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS
<br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR PREMISES Es occurrence S 500,000
<br /> MED EXP(Any one person) S 20,000
<br /> A X X 01-CP-0001391-01-02 06/05/2025 06/0512026 PERSONAL SADVINJURY $ 1,000,000
<br /> �G/E`N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 3,000,000
<br /> POLICY PRO
<br /> JECT LOC PRODUCTS-COMP/OP AGG 5 3,000,000
<br /> OTHER: S
<br /> AUTOMOBILE LIABILITY -COMBINEDSINGLELIMIT $ 1,000,000
<br /> Ea accident
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> A OWNED SCHEDULED X X 01-CP-0001391-01-02 (16/05/2025 06/05/2026 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS PROPERTY DAMAGE
<br /> x HIRED Ix
<br /> NQN-AWNED/�. AUTOS ONLY AUTOS ONLY IPer accident
<br /> $
<br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $
<br /> EEXCESS LIAR CLAIMS-MADE AGGREGATE S
<br /> DED I I RETENTION$ $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER
<br /> ANYPROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACC#DENT S 1,000.000
<br /> B OFFICERIMEMBEREXCLUDED? NIA 9100741-24 10/01/2024 10/01/2025
<br /> (Mandatary in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000
<br /> Limit $1,000,000
<br /> C Cyber Liability ESN0240065424 09/01/2024 10/01/2025 Ded. $2,500
<br /> DESCRIPTION OF OPERATIONS(LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> (Insurer A)-Sexual Misconduct,Physical Abuse,and Molestation Liability-01-CP-0001391-01-02-(06/05/2025-06/0512026)-Aggregate:$1,000,000.,Each
<br /> Occurrence:$1,000,000
<br /> (Insurer A)-Professional Liability-01-CP-0001391-01-02-(06/05/2025-06/0512026)-Aggregate:$2,000,000., Each Occurrence:$1,000,000
<br /> (Insurer A)-Liquor Liability-01-CP-0001391-01-02-(06/05/2025-06/05/2026)-Aggregate:$1,000,000.,Each Occurrence:$1,000,000
<br /> City of Santa Ana,its officers,officials,employees,and volunteers are included as an additional insured as required by a written contract with respect to General
<br /> Liability and Auto Liability.Waiver of subrogation applies with respect to General Liability,Auto Liability and Worker's Compensation as required by written
<br /> contract
<br /> CERTIFICATE HOLDER APPROVED �_ CANCELLATION
<br /> By Tu Tran Nguyen at 3:37 pm,Sets 19,2025 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Cityof Santa Ana Tu Tran D�OW11ys19.eddy ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Tu Tre Nguyen
<br /> Parks Recreation,and CommunityServices,M-23 Daic:202509,19
<br /> Nguyen rs3R9�-07na
<br /> 20 Civic Center Plaza AUTHORIZ ESENTATIVE
<br /> Santa Arta CA 92701
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<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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