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HomeMy WebLinkAboutCITY NET (KINGDOM CAUSES, INC.) (13) INSllRAiNU ON HLE WORK PRAY Pf'OCLEO U07 EXPI C; A-2025-085-ai CITY CLERK MAYOR DATE_ . CITY MANAGER Valerie Amezcua Mr� w" Alvaro Nunez MAYOR PRO TEM OCT 162D2rJ A—�,,,.�' CITY ATTORNEY Benjamin Vazquez Sonia R. Carvalho COUNCILMEMBERS m CITY CLERK Phil Bacerra _ #�--�-- Jennifer L. Hall Johnathan Ryan Hernandez Jessie Lopez David Penaloza o=GflA(li!V) Thai Viet Phan CITY OF SANTA ANA E�clwarct90C(07) COMMUNITY DEVELOPMENT AGENCY 20 Civic Center Plaza•P.O. Box 1988 Santa Ana,California 92702 www.santa-ana.ora October 1, 2025 Kingdom Causes, Inc., dba City Net Attention: Brad Fieldhouse, CEO 4508 Atlantic Ave., Ste. 292, Long Beach, CA 90807 Re: Extension of Agreement(A-2025-085)to Provide Substance Abuse Coordination Services Pursuant to Section 4("Term")of the above-referenced Agreement, entered into by Kingdom Causes, Inc., dba City Net, ("Consultant"), and the City of Santa Ana, dated June 17, 2025, the time period of the Agreement is hereby extended for an additional 6-month period through June 16, 2026. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely, Michael Gard , Executive Director, Community Development Agency CITY OF ANTA AN ATTEST < A varo Nunez er L at City Manager City C APPROVED AS TO FORM CONSULTANT Andrea Garcia-Miller ad Fieldhouse Senior Assistant City Attorney CEO SANTAANA CITY COUNCIL Valerie Amezcua Benjamin Vazquez Thai Viet Phan Jessie Lopez Phil Bacerra Johnathan Ryan Hernandez David Penaloza Mayor Mayor Pro Tem,Ward 2 Ward 1 Ward 3 Ward 4 Ward 6 Ward 5 vamezcua(c�sanla-ana.oftl byaZOuezlo7aanta-ana.oro tohan(asanta-ana.oro iesslelop Z rdPnta„ana_orq abacerraoganta-ana.om irrvanhemandez688nta-ana.ol0 dbenalozeft�.aanla-ana.orq CITYNET-02 ASUGABAR CERTIFICATE OF LIABILITY INSURANCE DATE1 6l18120vYYY) 12025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in_lieu of such endorsement(s). PRODUCER License#0757776 CONTACT Amy tuugahara HUB International Insurance Services Inc. PHONE 1625 Faraday Avenue (A1C,No,Ext),.(442)244-6917 FAX No): Suite 150 ao r& .amy.sugahara@hubinternational.com Carlsbad,CA 92008 INSURER(S)AFFORDING COVERAGE NAIL x INSURER A:Philadelphia Indemnitv Insurance Company 18058 INSURED INSURER B:Berkshire Hathaway Homestate Insurance Company 20044 Kingdom Causes,Inc.dba City Net 4508 Atlantic Ave INSURER C Suite 292 INSURER D Long Beach,CA 90807--1520 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI00 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_. INSR TYPE OF INSURANCE_ Y ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP WY D LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 3 2,000,000 CLAIMS-MADE LX] OCCUR PHPK2663022-015 3/1612025 311/2026 PR MISErORENTED 3 100,000 -- MED EXP(Any oneperson) S 5,Daa PERSONAL&ADV INJURY S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 4,000,000 PRO- PRODUCTS POLICY JECT LOC PRODUCTS-COMPIOPAGG 3 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,aaa,000 3 ANY AUTO PHPK2708361-000 3/16/2025 311/2026 BODILY INJURY Perperson) S OWNED AUTOS ONLY X A SCHEDULED BODILY INJURY Per accident 3 X AU X AUSONL�TOS ONLY O POad� DAMAGE S A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE 3 5,000,000 EXCESS UAB CLAIMS-MADE PHUS903241-005 3/16/2025 31112026 AGGREGATE y 5,000,000 DED X RETENTIONS 10,000 S B WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITY YIN N T'FIJTE ER ANY PROPRl£TORIPARTNERJEXECUTIVE KlWC625771 3/1/2025 311/2026 1,OOa OOa E.L.EACH ACCIDENT $ OFFICERfMEMBE EXCLUOEO9 N 1 A e {MMandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE S 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,oDa A Misconduct/Abuse PHPK2663022-015 311612025 31112026 See Below for Limits A Professional Liab PHPK2663022-015 3/1612025 31112026 See Below for Limits DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Umbrella Liability applies to General Liability, Employers Liability,Professional Liability and Abuse and Misconduct Liability Only 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 captioned general liability policy where required by written contract.A Waiver of Subrogation also applies to the above captioned general liability policy where required by written contract, TU TCan °9Raoy"r by Professional Liability I Occurrence Form 1$1,000,000 Each Occurrence 1$2.000,000 Aggregate I No Deductible T.rm o2sne.itAbuse&Misconduct Liability I Occurrence Form 1$1,000,000 Each Occurrence 1$1,000,000 Aggregate I No Deductible Nguyen 02 06s9-071 SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION APPINUM) 9y Tu Tram Nguyen of 12:06 pm,Jun 19,2025 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana-Substance Abuse Treatment Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Attention:Executive Director Community Development Agency 20 Civic Center Plaza M-30 AUTHORIZED REPRESENTATIVE Santa Ana,CA 92701 J/1.1 _ ACORD 25(2016/03) t01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER lD:CITYNET-02 � — ASUGAHARA LOG A 'I ACORD" ADDITIONAL REMARKS SCHEDULE Page 1 ref 1 AGENCY Llconso#476 7% NAMED INSUReo t113 International Insuran_ce Services Inc. Kingdom Causes,Inc.dba City Not 4608 Atlantic Ave POLICY NUMBERButts 202 Egos naei s'CA 9080 --1 sxn E PAGE 1 CARRIER... .... - EE PAGE 1 SEEP 1 srlVcnve WE: GE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACOND FORM, FORM NUMBER; ACOftD 2626 FORM TITLE: caryffcate of Uphiiity Insuranaq--- ......_.,..me_µ,. Description of OporationslLocatlonsNehicies: Cybor Liability[Coalition Insurance Companyl Claims Madel Retroactive Cate: Full Prior Acts Continuity Date:October 19,2022 1 $2,000,000 Aggregate lRetention$10,000 I I ACORD 101(20OW01) q 2008 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of AGORD PI-GLD-hIS (10/11) THIS ENDORSEME T CHANGES THE POLICY. PLEASE READ IT CAREFULLY, GENERAL LIAEILITY'DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It Is understood and agreed that the following extensions only apply In the event that no other specific coverage for the Indicated loss exposure Is provided under this policy. If such specific coverage applies,the terms,conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy,unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific ooverages, consult the policy contract wording. Coverage Applicable Limit of insurance Page# Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $60,000 limit Non-Owned Wateraoft Lass than 58 feet 2� Damage to Property You Own, Rent, or Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 s HIPAA µ" Clarification 4 Medical Payments $20,000 6 Medical Payments-Extended Reporting Period 3 years " 6 Athletic Activities Amentted 6 Supplementary Payments--Ball Bonds $5,000 6 Supplementary payment-Lo'ss of Eamings $1,000 per day 6 Employee Indemnification Defense Coverage $26,000 5 Key and Lock Replacement-Janitorial Services Client Coverage — '000 limit 6 Additional Insured-Newly Acquired Time Period Amended 6 Additional Insured-Medical Directors and Administrators Included 7 Additional Insured-Managers and Supervisors (with Fellow Included 7 I~mpl�ea Covera e Additional Insured.M Broadened Named Insured Included 7 Additional Insured-Funding Source Included 7 Additional Insured--Home Caro Providers Included 7 Additional Insured-Managers, Landlords, or Lessors of Premises Included 7 Additional Insured,Lessor of Leased Equipment Included 7 Additional Insured-Grantor of Permits Included 8 Additional Insured-Vendor Included 8 Additional Insured-Franchisor Included 9 Additional Insured- k+ n ke_qu red by Contract Included g Additional Insured-Owners, Lessees, or Contractors Included 9 Additional Insured-State or Political Subdivisions " Included 10W Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission, 62011 Philadelphia Indemnity Insurance Company PI-OLD-HS (10/11) Duties In the Event of Occurrence. Claim or Suit Included 10 Unlntentionei Failure to Disclose Hazards Included 10 Transfer of Rights of Recovery Against Others To Us CIarIfloativn 10 Liberailzatlon Included 11 Oodily Injury—Includes Mantel Anguish Included 11 Personal and Advertising Injury—includes Abuse of Process, Included 11 Discrimination A. Extended Property Damage SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a. Is deleted in Its entirety and replaced by the following: a. Expected or Intended Injury "Bodily Injury"or property damage"expected or intended from the standpoint of the Insured. This exclusion does not apply to"bodily Injury"or"property damage" resulting from the use of reasonable force to protect persons or property. B. Limited Rental Lease Agreement Contractual Liability SECTION I—COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph b.Contractual'Liability is amended to include the following; (3) Based on the named Insured's request at the time of claim,we agree to indemnify the named Insured for their Iiab€Ilty assumed In a contract or agreement regarding the rental or lease of a premises on behalf of-their client, up to$50,000; This coverage extension only applies to rental lease agreements, This coverage is excess over any renter's liability insurance of the client, C, Non-Owned Watercraft SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY. Subsection 2. Exclusions, paragraph g. (2) Is deleted in Its entirety and replaced by the following; (2) A watercraft you do not own that is: (a) Less than 55 feet long; and (b) Not bel'ng used to carry persons or property for al'charge; This provision applies to any parson, who with your consent, ether uses or is responsible for the use of a watercraft. This insurance Is excess over any other valid and collectible Insurance available to the insured whether primary, excess or contingent. D. Damage to Property You Own,Rent or Occupy SECTION I--COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE Page 2 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with Its permission. 0 2011 Philadelphia Indemnity Insurance Company i I PI-GLD.HS (10/11) LIABILITY, Subsection 2. Exclusions, Paragraph j. damage to Property, Item(1) is deleted In Its entirety and replaced with the following: (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person, organization or entity,for repair, replacement,enhancement, restoration or maintenance of such property for any reason, Including prevention of Injury to a person or damage to another's property, unless the damage to property Is caused by your client, up to a $30,000 limit. A client is defined as a person under your direct care and supervision. E. Damage to Premises Rented to You 1. If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, the word "fire"Is changed to"fire, lightning, explosion, smoke, or leakage from automatic fire protective systems"where It appears In: a. The last paragraph of SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2, Exclusions; is deleted In Its entirety and replaced by the following: Exclusions c.through n.do not apply to damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner..A separate limit of insurance applies to this coverage as described in SECTION III—LIMITS OF INSURANCE. b. SECTION III—LIMITS OF INSURANCE, Paragraph 6, Is deleted in its entirety and replaced by the following: Subject to Paragraph 6. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage"to any one premises, while rented to you, or In the case of damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems while rented to you or temporarily occupied by you with permission of the owner. c. SECTION V—DEFINITIONS, Paragraph 9.a., is deleted in Its entirety and replaced by the following: A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "Insured contract"; 2. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4.Other Insurance, Paragraph b. Excess Insurance, (1) (a)(li) is deleted In its entirety and replaced by the following: That Is insurance for fire, lightning,explosion, smoke, or leakage from automatic fire protective systems for premises rented to you or temporarily occupied by you with permission of the owner; 3. The damage To Premises Rented To You Limit section of the Deolarations Is amended to the greater of; Pager 3 of 12 Includes copyrighted material of Insurance Services Office, Inc,, with Its permission. 0 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10111) a. $1,000,000; or b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit, This is the most we will pay for all damage proximately caused by the same event,whether such damage results from fire,lightning, explosion, smoke,or leaks from automatic fire protective systems or any combination thereof. F. HIPAA SECTION I COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, is amended as follows: 1. Paragraph 1. Insuring Agreement is amended to Include the following. We will pay those sums that the insured becomes legally obligated to pay as damages because of a"violation(s)"of the Health Insurance Portabillty and Accountability Act(HIPAA). We have the right and the duty to defend the insured against any"suit,""Investigation,"or"olvil proceeding" seeking these damages. However,we will have no duty to defend the Insured against any"cult" seeking damages, "investigatlon,"or"civil proceeding"to which this insurance does not apply. 2. Paragraph 2.Exclusions Is amended to include the following additional exclusions: This insurance does not apply to: a. Intentional,Willful,or Deliberate Violations Any willful, Intentional, or deliberate'Molation(s)M by any insured. b. Criminal Acts Any"violation"which results in any criminal penalties under the HIPAA. c. Other Remedies Any remedy other than monetary damages for penalties assessed. d. Compliance Reviews or Audits Any compliance reviews by the Department of Health and Human Services. 3. SECTION V—DEFINITIONS Is amended to include the following additional definitions: a. "Civil proceeding"means an action by the Department of Health and Human Services (HHS) arising out of"violations." b. "Investigation"means an examination of an actual or alleged"violation(s)"by H-IS, However, "investlgation"does not include a Compliance Review. a. "Violation"means the actual or alleged failure to comply with the regulations included in the HIPAA. Rage 4 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 02011 Philadelphia Indemnity Insurance Company . PI-GLIB-HS(10/11) G. Medical Payments--Limit Increased to$20,000, Extended Reporting Period If COVERAGE C MEDICAL PAYMENTS Is not otherwise excluded from this Coverage Part; 1. The Medical Expense Limit is changed subject to all of the terms of SECTION Ill-LIMITS OF INSURANCE to the greater of; a. $20,000; or b. The Medical Expense Limit shown in the Declarations of this Coverage Part. 2. SECTION I--COVERAGE, COVERAGE C MEDICAL PAYMENTS, Subsection 1.Insuring Agreement, a. (3) (b) is deleted in its entirety and replaced by the fallowing: (b) The expenses are Incurred and reported to us within three years of the date of the accident. H. Athletic Activities SECTION I—COVERAGES, COVERAGE C MEDICAL PAYMENTS, Subsection 2.Exclusions, Paragraph e.Athletic Activities is deleted In its entirety and replaced with the following: e. Athletic Activities To a person injured while taking part In athletics. I. Supplementary Payments SECTION I--COVERAGES, SUPPLEMENTARY PAYMENTS-COVERAGE A AND B are amended as follows:. 1. b. is deleted In Its entirety and replaced by the following: 1. b. Up to$5000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these. 14. Is deleted in Its entirety and replaced by the following: 1. d. All reasonable expenses incurred by the insured at our request to assist us in the Investigation or defense of the claim or"suit", including actual loss of earnings up to$1,000 a day because of time off from work. J. Employee Indemnification Defense Coverage SECTION I--COVERAGES,,SUPPLEMENTARY PAYMENTS—COVERAGES A AND B the following is added: We will pay, on your behalf, defense costs incurred by an"employee" in a criminal proceeding occurring in the course of employment. The most we will pay for any"employee" who is alleged to be directly involved in a criminal proceeding Is$25,000 regardless of the numbers of"employees,"claims or°suits"brought or persons or organizations making claims or bringing"suits. Page 5 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 2011 Philadelphia Indemnity Insurance Company Pi-CLD-HS(10/11) K. Key and Lock Replacement—Janitorial Services Client Coverage SECTION I--COVERAGES, SUPPLEMENTARY PAYMENTS—COVERAGES A AND B Is amended to include the foilowing; We will pay for the cost to replace keys and locks at the"clients" premises due to theft or other loss to keys entrusted to you by your"client," up to a$10,000 Ilmit per occurrence and $10,000 policy aggregate. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners,members, officers, "employees","managers",directors,trustees, authorized representatives or any one to whom you entrust the keys of a"client"for any purpose commit, whether acting alone or In collusion with otter persons. The following,when used on this coverage, are defined as follows. a. "Client"means an individual, company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee" means: (1) Any natural person: (a) While in your service or for 30 days after termination of service; (b) Who you compensate directly by salary,wages or commissions;and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you; (a) To substitute for a permanent"employee"as defined in Paragraph(1)above,who is on leave; or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee"does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm, factor, commission merchant,consignee, Independent contractor or representative of the same general Character;or (b) Any"manager,"director or trustee except while performing acts coming within the scope of the usual duties of an"employee." c. "Manager' means a person serving in a directorial rapacity for a limited liability company. L. Additional Insureds SECTION II—WHO IS AN INSURED is amended as follows: 1. If coverage for newly acquired or formed organizations Is not otherwise excluded from this Page 6 of 12 Includes copyrighted material of Insurance Services Office, Inc., with Its permission. 02011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) Coverage Part, Paragraph 3.a. Is deleted in Its entirely and replaced by the following: a. Coverage under this provision is afforded until the end of the policy period. 2. Each of the following Is also an insured; a. Medical [directors and Administratoes—Your medical directors and administrators, but only white acting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist In the treatment of a patient. b. Managers and Supervisors—Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and supervisors who are your"employees"are also insureds For"bodily injury"to a co- "employee"while In the course of his or her employment by you or performing duties related to the conduct of your business. This provision does not change Item 2.a,(I)(a) as It applies to managers of a limited liability company. c. Broadened Named Insured—Any organization and subsidiary thereof which you control and actively manage on the effective data of this Coverage Part. However, coverage does not apply to any organization or subsidiary not named In the Declarations as Named Insured, if they are also insured under another similar policy, but for Its termination or the exhaustion of Its limits of Insurance. d. Funding Source—Any person or organization with respect to their liability arising out of; (1) Their financial control of you;or (2) premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. e, Home Care Providers—At the first Named.Insured's option, any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled. f, Managers, Landlords, or Lessors of Premises—Any person or organization with respect to their liability arising out of the ownership, malntenaneo or use of that part of the premises leased or rented to you subject to the following additional exclusions: This insurance does not apply to: (1) Any"occurrence"which takas place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. g. Lessor of Leased Equipment—Automatic Status When Required in Lease Agreement With You—Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be addled as an additional Insured on your policy. Such person or Page 7 of 12 Includes copyrighted material of Insurance Services Office, Inc., with Its permission, 2011 Philadelphia Indemnity Insurance Company CITYNET-02 ASUGAHARA ,d►coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/16/2026 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#0757776 CONTACT Amy Sugahara NAME: HUB International Insurance Services Inc. PHONE FAX 1525 Faraday Avenue (A/C,No,Ext):(442)244-6917 (A/C,No): Suite 150 E-MAIL-ADDRESS:amy.sugahara@hubinternational.com Carlsbad,CA 92008 INSURERS AFFORDING COVERAGE NAIC# INSURERA:Philadelphia Indemnity Insurance Company 18058 INSURED INSURER B:Berkshire Hathaway Homestate Insurance Company 20044 Kingdom Causes,Inc.dba City Net INSURER C:Travelers Excess and Surplus Lines Company 29696 4508 Atlantic Ave Suite 292 INSURER 7 Long Beach,CA 90807-1520 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PHPK2663022-016 3/1/2026 3/1/2027 DAMAGE TO RENTED 1,000,000 X X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 20,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 3,000,000 JECT OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO X PHPK2663022-016 3/1/2026 3/1/2027 BODILY INJURY Perperson) $ OWNED SCHEDULED X AUTOS ONLY X AUTOS BODILY INJURY Per accident $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident) ccident $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE PHUB903241-005 3/1/2026 3/1/2027 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ B WORKERS COMPENSATION X PER STATUTE E ERR AND EMPLOYERS'LIABILITY X KIWC726715 3/1/2026 3/1/2027 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Cyber/Privacy/Networ C-4LPY-047969-CYBER-2026 3/1/2026 3/1/2027 Per Event 2,000,000 A Misconduct/Abuse PHPK2663022-016 3/1/2026 3/1/2027 See Below for Limits DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Umbrella Liability follows the following forms,General Liability,Employers Liability,Professional Liability and Abuse and Misconduct Liability Only 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 captioned general liability policy where required by written contract.A Waiver of Subrogation also applies to the above captioned general liability policy where required by written contract. Professional Liability I Occurrence Form 1$1,000,000 Each Occurrence $2,000,000 Aggregate I No Deductible Policy#PHPK27 08 361-0 00 CERTIFICATE HOLDER APPROVED CANCELLATION By Tu Tran Nguyen at 8:49 am,Apr 27,2026 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Homeless Services Division 20 Civic Center Plaza Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:CITYNET-02 ASUGAHARA LOC#: 0 ACORO ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY License#0757776 NAMED INSURED HUB International Insurance Services Inc. Kingdom Causes,Inc.dba City Net 4508 Atlantic Ave POLICY NUMBER Suite 292 Long Beach,CA 90807-1520 SEE PAGE 1 Los Angeles CARRIER NAIC CODE SEE PAGE 1 SEE P 1 EFFECTIVE DATE:SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/Locations/Vehicles: Abuse&Misconduct Liability I Occurrence Form 1 $1,000,000 Each Occurrence 1 $1,000,000 Aggregate No Deductible Cyber Liability )Coalition Insurance Company) 03/01/2026-03/01/2027 1 Claims Madel Retroactive Date: Full Prior Acts I Continuity Date: October 19, 2022 1 $2,000,000 Aggregate I Retention $10,000 Umbrella Liability Policy extends over General Liability, Employers Liability and Professional Liability ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PHPK2708361-000 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 03/16/2025 Countersigned By: Named Insured: Kingdom Causes, Inc. Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑ PI-CANXAICH-002 (05/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION NOTICE TO SCHEDULED ADDITIONAL INSURED OR CERTIFICATE HOLDER This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROFESSIONAL LIABILITY COVERAGE PART COMMERCIAL CRIME COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART SCHEDULE OF ADDITIONAL INSUREDS OR CERTIFICATE HOLDERS Al or CH Additional Insured or Certificate Holder Address CH City of Santa Ana Risk Management 20 Civic Center Plaza FL 4 Division Santa Ana CA 92701 The following is added to A. CANCELLATION of the Common Policy Conditions of the above applicable coverage part: A. In the event we cancel the policy in accordance with the policy's terms and conditions, we will endeavor to mail written notice of cancellation to Additional Insureds or Certificate Holders, shown in the above SCHEDULE within the time frame listed below. However, failure to mail such notice shall impose no obligation of any kind upon us, our agents or representatives. 1. 30 days before the effective date of cancellation if we cancel for any reason other than for non -payment of premium. As respects Additional Insureds, the above cancellation provision applies only when the Additional Insured shown in the above SCHEDULE is added to the policy by a separate additional insured endorsement as the CANCELLATION NOTICE TO ADDITIONAL INSURED OR CERTIFICATE HOLDER does not provide additional insured coverage. Page 4 of 37 Policy #PHPK2663022-016 PI-GLD-HS (10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies,the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. Coverage Applicable Limit of Insurance Page# Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 Non-Owned Watercraft Less than 58 feet 2 Damage to Property You Own, Rent, or Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 3 HIPAA Clarification 4 Medical Payments $20,000 5 Medical Payments—Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supplementary Payments—Bail Bonds $5,000 5 Supplementary Payment—Loss of Earnings $1,000 per day 5 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement—Janitorial Services Client Coverage $10,000 limit 6 Additional Insured—Newly Acquired Time Period Amended 6 Additional Insured—Medical Directors and Administrators Included 7 Additional Insured—Managers and Supervisors (with Fellow Included 7 Employee Coverage) Additional Insured—Broadened Named Insured Included 7 Additional Insured—Funding Source Included 7 Additional Insured—Home Care Providers Included 7 Additional Insured—Managers, Landlords, or Lessors of Premises Included 7 Additional Insured—Lessor of Leased Equipment Included 7 Additional Insured—Grantor of Permits Included 8 Additional Insured—Vendor Included 8 Additional Insured—Franchisor Included 9 Additional Insured—When Required by Contract Included 9 Additional Insured—Owners, Lessees, or Contractors Included 9 Additional Insured—State or Political Subdivisions Included 10 Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) Duties in the Event of Occurrence, Claim or Suit Included 10 Unintentional Failure to Disclose Hazards Included 10 Transfer of Rights of Recovery Against Others To Us Clarification 10 Liberalization Included 11 Bodily Injury—includes Mental Anguish Included 11 Personal and Advertising Injury—includes Abuse of Process, Included 11 Discrimination A. Extended Property Damage SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a. is deleted in its entirety and replaced by the following: a. Expected or Intended Injury "Bodily injury" or property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or"property damage" resulting from the use of reasonable force to protect persons or property. B. Limited Rental Lease Agreement Contractual Liability SECTION I—COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph b. Contractual Liability is amended to include the following: (3) Based on the named insured's request at the time of claim, we agree to indemnify the named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client, up to $50,000. This coverage extension only applies to rental lease agreements. This coverage is excess over any renter's liability insurance of the client. C. Non-Owned Watercraft SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph g. (2) is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess or contingent. D. Damage to Property You Own, Rent or Occupy SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE Page 2 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) LIABILITY, Subsection 2. Exclusions, Paragraph j. Damage to Property, Item (1) is deleted in its entirety and replaced with the following: (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property, unless the damage to property is caused by your client, up to a $30,000 limit. A client is defined as a person under your direct care and supervision. E. Damage to Premises Rented to You 1. If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, the word "fire" is changed to "fire, lightning, explosion, smoke, or leakage from automatic fire protective systems"where it appears in: a. The last paragraph of SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions; is deleted in its entirety and replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in SECTION III— LIMITS OF INSURANCE. b. SECTION III— LIMITS OF INSURANCE, Paragraph 6. is deleted in its entirety and replaced by the following: Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage" to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems while rented to you or temporarily occupied by you with permission of the owner. c. SECTION V— DEFINITIONS, Paragraph 9.a., is deleted in its entirety and replaced by the following: A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; 2. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4. Other Insurance, Paragraph b. Excess Insurance, (1) (a) (ii) is deleted in its entirety and replaced by the following: That is insurance for fire, lightning, explosion, smoke, or leakage from automatic fire protective systems for premises rented to you or temporarily occupied by you with permission of the owner; 3. The Damage To Premises Rented To You Limit section of the Declarations is amended to the greater of: Page 3 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) a. $1,000,000; or b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit. This is the most we will pay for all damage proximately caused by the same event, whether such damage results from fire, lightning, explosion, smoke, or leaks from automatic fire protective systems or any combination thereof. F. HIPAA SECTION I—COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, is amended as follows: 1. Paragraph 1. Insuring Agreement is amended to include the following: We will pay those sums that the insured becomes legally obligated to pay as damages because of a "violation(s)" of the Health Insurance Portability and Accountability Act (HIPAA). We have the right and the duty to defend the insured against any"suit," "investigation," or"civil proceeding" seeking these damages. However, we will have no duty to defend the insured against any"suit' seeking damages, "investigation," or"civil proceeding" to which this insurance does not apply. 2. Paragraph 2. Exclusions is amended to include the following additional exclusions: This insurance does not apply to: a. Intentional,Willful, or Deliberate Violations Any willful, intentional, or deliberate "violation(s)" by any insured. b. Criminal Acts Any"violation"which results in any criminal penalties under the HIPAA. c. Other Remedies Any remedy other than monetary damages for penalties assessed. d. Compliance Reviews or Audits Any compliance reviews by the Department of Health and Human Services. 3. SECTION V— DEFINITIONS is amended to include the following additional definitions: a. "Civil proceeding" means an action by the Department of Health and Human Services (HHS) arising out of"violations." b. "Investigation" means an examination of an actual or alleged "violation(s)" by HHS. However, "investigation" does not include a Compliance Review. c. "Violation" means the actual or alleged failure to comply with the regulations included in the HIPAA. Page 4 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) G. Medical Payments— Limit Increased to $20,000, Extended Reporting Period If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part: 1. The Medical Expense Limit is changed subject to all of the terms of SECTION III - LIMITS OF INSURANCE to the greater of: a. $20,000; or b. The Medical Expense Limit shown in the Declarations of this Coverage Part. 2. SECTION I—COVERAGE, COVERAGE C MEDICAL PAYMENTS, Subsection 1. Insuring Agreement, a. (3) (b) is deleted in its entirety and replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident. H. Athletic Activities SECTION I—COVERAGES, COVERAGE C MEDICAL PAYMENTS, Subsection 2. Exclusions, Paragraph e. Athletic Activities is deleted in its entirety and replaced with the following: e. Athletic Activities To a person injured while taking part in athletics. I. Supplementary Payments SECTION I—COVERAGES, SUPPLEMENTARY PAYMENTS - COVERAGE A AND B are amended as follows: 1. b. is deleted in its entirety and replaced by the following: 1. b. Up to $5000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these. 1.d. is deleted in its entirety and replaced by the following: 1. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or"suit", including actual loss of earnings up to $1,000 a day because of time off from work. J. Employee Indemnification Defense Coverage SECTION I—COVERAGES, SUPPLEMENTARY PAYMENTS—COVERAGES A AND B the following is added: We will pay, on your behalf, defense costs incurred by an "employee" in a criminal proceeding occurring in the course of employment. The most we will pay for any"employee" who is alleged to be directly involved in a criminal proceeding is $25,000 regardless of the numbers of"employees," claims or"suits" brought or persons or organizations making claims or bringing "suits. Page 5 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) K. Key and Lock Replacement—Janitorial Services Client Coverage SECTION I—COVERAGES, SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended to include the following: We will pay for the cost to replace keys and locks at the "clients" premises due to theft or other loss to keys entrusted to you by your"client," up to a $10,000 limit per occurrence and $10,000 policy aggregate. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners, members, officers, "employees", "managers", directors, trustees, authorized representatives or any one to whom you entrust the keys of a "client" for any purpose commit, whether acting alone or in collusion with other persons. The following, when used on this coverage, are defined as follows: a. "Client" means an individual, company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee" means: (1) Any natural person: (a) While in your service or for 30 days after termination of service; (b) Who you compensate directly by salary, wages or commissions; and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent"employee" as defined in Paragraph (1) above, who is on leave; or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee" does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm, factor, commission merchant, consignee, independent contractor or representative of the same general character; or (b) Any"manager," director or trustee except while performing acts coming within the scope of the usual duties of an "employee." c. "Manager" means a person serving in a directorial capacity for a limited liability company. L. Additional Insureds SECTION II—WHO IS AN INSURED is amended as follows: 1. If coverage for newly acquired or formed organizations is not otherwise excluded from this Page 6 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) Coverage Part, Paragraph 3.a. is deleted in its entirely and replaced by the following: a. Coverage under this provision is afforded until the end of the policy period. 2. Each of the following is also an insured: a. Medical Directors and Administrators—Your medical directors and administrators, but only while acting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist in the treatment of a patient. b. Managers and Supervisors—Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and supervisors who are your"employees" are also insureds for"bodily injury" to a co- "employee" while in the course of his or her employment by you or performing duties related to the conduct of your business. This provision does not change Item 2.a.(1)(a) as it applies to managers of a limited liability company. c. Broadened Named Insured—Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However, coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured, if they are also insured under another similar policy, but for its termination or the exhaustion of its limits of insurance. d. Funding Source —Any person or organization with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. e. Home Care Providers—At the first Named Insured's option, any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled. f. Managers, Landlords, or Lessors of Premises —Any person or organization with respect to their liability arising out of the ownership, maintenance or use of that part of the premises leased or rented to you subject to the following additional exclusions: This insurance does not apply to: (1) Any"occurrence" which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. g. Lessor of Leased Equipment—Automatic Status When Required in Lease Agreement With You —Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be added as an additional insured on your policy. Such person or Page 7 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) organization is an insured only with respect to liability for"bodily injury," "property damage" or "personal and advertising injury' caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any"occurrence"which takes place after the equipment lease expires. h. Grantors of Permits—Any state or political subdivision granting you a permit in connection with your premises subject to the following additional provision: (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with the premises you own, rent or control and to which this insurance applies: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance, or use of any elevators covered by this insurance. i. Vendors—Only with respect to "bodily injury" or"property damage" arising out of"your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: (1) The insurance afforded the vendor does not apply to: (a) "Bodily injury" or"property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; Page 8 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) 'Bodily injury" or"property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i) The exceptions contained in Sub-paragraphs (d) or J); or (ii) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing. j. Franchisor—Any person or organization with respect to their liability as the grantor of a franchise to you. k. As Required by Contract—Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional insured for"bodily injury," "property damage" or"personal and advertising injury" but only for liability arising out of the negligence of the named insured. The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of insurance shown in the Declarations I. Owners, Lessees or Contractors —Any person or organization, but only with respect to liability for"bodily injury," "property damage" or"personal and advertising injury" caused, in whole or in part, by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured when required by a contract. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or"property damage" occurring after: (a) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (b) That portion of"your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 9 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) m. State or Political Subdivisions —Any state or political subdivision as required, subject to the following provisions: (1) This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit, and is required by contract. (2) This insurance does not apply to: (a) 'Bodily injury," "property damage"or"personal and advertising injury" arising out of operations performed for the state or municipality; or (b) 'Bodily injury" or"property damage" included within the "products-completed operations hazard." M. Duties in the Event of Occurrence, Claim or Suit SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 2. is amended as follows: a. is amended to include: This condition applies only when the "occurrence" or offense is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. b. is amended to include: This condition will not be considered breached unless the breach occurs after such claim or"suit' is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. N. Unintentional Failure To Disclose Hazards SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, 6. Representations is amended to include the following: It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. O. Transfer of Rights of Recovery Against Others To Us SECTION IV— COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer of Rights of Page 10 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) Recovery Against Others To Us is deleted in its entirety and replaced by the following: If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit"or transfer those rights to us and help us enforce them. Therefore, the insured can waive the insurer's rights of recovery prior to the occurrence of a loss, provided the waiver is made in a written contract. P. Liberalization SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, is amended to include the following: If we revise this endorsement to provide more coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. Q. Bodily Injury— Mental Anguish SECTION V— DEFINITIONS, Paragraph 3. Is deleted in its entirety and replaced by the following: "Bodily injury" means: a. Bodily injury, sickness or disease sustained by a person, and includes mental anguish resulting from any of these; and b. Except for mental anguish, includes death resulting from the foregoing (Item a. above) at any time. R. Personal and Advertising Injury—Abuse of Process, Discrimination If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluded from this Coverage Part, the definition of"personal and advertising injury" is amended as follows: 1. SECTION V— DEFINITIONS, Paragraph 14.b. is deleted in its entirety and replaced by the following: b. Malicious prosecution or abuse of process; 2. SECTION V— DEFINITIONS, Paragraph 14. is amended by adding the following: Discrimination based on race, color, religion, sex, age or national origin, except when: a. Done intentionally by or at the direction of, or with the knowledge or consent of: (1) Any insured; or (2) Any executive officer, director, stockholder, partner or member of the insured; b. Directly or indirectly related to the employment, former or prospective employment, termination of employment, or application for employment of any person or persons by an insured; Page 11 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) c. Directly or indirectly related to the sale, rental, lease or sublease or prospective sales, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured; or d. Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, court decision or administrative ruling. The above does not apply to fines or penalties imposed because of discrimination. Page 12 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 10 C (Ed. 01-19) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) The additional premium for this endorsement shall be calculated by applying a factor of 2% to the total manual premium, with a minimum initial charge of$350, then applying all other pricing factors for the policy to this calculated charge to derive the final cost of this endorsement. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Blanket Waiver Person/Organization Blanket Waiver—Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Premium (prior to adjustments) All CA Operations This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required onlywhen this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective:3/l/2026-3/l/2027 Policy No.:MCE 5771 Endorsement No.: 1 Insured:Kingdom Causes, Inc.dba City Net Premium$ Insurance Company: Berkshire Homestate Hathaway Company Countersigned by WC 99 04 10 C (Ed.01-19) POLICY NUMBER: PHPK2663022-016 COMMERCIAL AUTO CA 04 44 03 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Kingdom Causes, Inc. Endorsement Effective Date: 03/01/2026 SCHEDULE Name(s) Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Oth- ers To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "ac- cident" or the "loss" under a contract with that person or organization. CA 04 44 03 10 © Insurance Services Office, Inc., 2009 Page 2 of 2 0 PI-HS-011 (07/04) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: HUMAN SERVICES ORGANIZATION PROFESSIONAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: As required per formal written contract City of Santa Ana The person or organization listed above is an additional insured when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability arising out of your ongoing operations performed for that additional insured. A person's or organization's status as an additional insured ends when your operations for that additional insured are completed. Page 1 of 1