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CITYNET-02 ASUGAHARA
<br /> ,d►coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 4/16/2026
<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 Amy Sugahara
<br /> NAME:
<br /> HUB International Insurance Services Inc. PHONE FAX
<br /> 1525 Faraday Avenue (A/C,No,Ext):(442)244-6917 (A/C,No):
<br /> Suite 150 E-MAIL-ADDRESS:amy.sugahara@hubinternational.com
<br /> Carlsbad,CA 92008
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA:Philadelphia Indemnity Insurance Company 18058
<br /> INSURED INSURER B:Berkshire Hathaway Homestate Insurance Company 20044
<br /> Kingdom Causes,Inc.dba City Net INSURER C:Travelers Excess and Surplus Lines Company 29696
<br /> 4508 Atlantic Ave
<br /> Suite 292 INSURER 7
<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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MM/DD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR PHPK2663022-016 3/1/2026 3/1/2027 DAMAGE TO RENTED 1,000,000
<br /> X X PREMISES Ea occurrence $
<br /> MED EXP(Any oneperson) $ 20,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000
<br /> POLICY PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 3,000,000
<br /> JECT
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO X PHPK2663022-016 3/1/2026 3/1/2027 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> X AUTOS ONLY X AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident)
<br /> ccident $
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> EXCESS LIAB CLAIMS-MADE PHUB903241-005 3/1/2026 3/1/2027 AGGREGATE $ 5,000,000
<br /> DED X RETENTION$ 10,000 $
<br /> B WORKERS COMPENSATION X PER STATUTE E ERR
<br /> AND EMPLOYERS'LIABILITY
<br /> X
<br /> KIWC726715 3/1/2026 3/1/2027 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> C Cyber/Privacy/Networ C-4LPY-047969-CYBER-2026 3/1/2026 3/1/2027 Per Event 2,000,000
<br /> A Misconduct/Abuse PHPK2663022-016 3/1/2026 3/1/2027 See Below for Limits
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Umbrella Liability follows the following forms,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
<br /> required by written contract.
<br /> Professional Liability I Occurrence Form 1$1,000,000 Each Occurrence $2,000,000 Aggregate I No Deductible Policy#PHPK27 08 361-0 00
<br /> CERTIFICATE HOLDER APPROVED CANCELLATION
<br /> By Tu Tran Nguyen at 8:49 am,Apr 27,2026
<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 /> Attn: Homeless Services Division
<br /> 20 Civic Center Plaza
<br /> Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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