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A� V CERTIFICATE OF LIABILITY INSURANCE (MMIDDryY DATE 5/8/2019 v ) 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 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 Clinton Polley Insurance Group, Inc. 12150 Tributary Point Dr #200 Gold River CA 95670 CONTACT NAME: Clinton PolleyInsurance Group, Inc. PHONE FAX 916-984-3000 (AID.Ro:916-984-3100 aooale certificates Clinton olle .com INSURERS AFFORDING COVERAGE NAIC N INSURER A: Philadelphia Insurance COm an INSURED STRAI.1 Straight Talk Clinic Inc 5712 Camp Street INSURER B: PHILADELPHIA IND INS CO 18058 INSURER c: OAK RIVER INS CO 34630 INSURER D : Cypress CA 90630 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 871643829 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. ILTR TYPE OF INSURANCE ADDL SUBR NUMBER POLICPOLICY MMIDDYEFF MIYY MMI�DY� LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y PHPKI646981 7/l/2018 7/l/2019 EACH OCCURRENCE $1.000,000 CLAIMS -MADE � OCCUR DAMAGE( RENTED PREMISESSEa occurrence) $100, 000 MED EXP (Any one person) $ 5,000 PERSONAL B ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 GEN'L X POLICY❑ JPRCOT LOC PRODUCTS - COMPIOP AGG $3,000,000 $ OTHER: A AUTOMOBILE LIABILITY PHPK1846981 7/1/2018 7/1/2019 COMBINED SINGLE LIMIT (Ed accident) $1000000 BODILY INJURY(Per person) $ AUTO IANY ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS X AONOOSWNED PRaOPERTY, AMAGE$ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE OED RETENTION$ $ O WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN Y STWCR27705 7/1/2018 7/1/2019 X PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $1,000.000 (Mandatory In NH) If yes, describe under DE SCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000000 A Professional Uabllily Including Sexual Abuse Liability PHPK1846981 7/1/2018 7/1/2019 1,000,000 each 3000.000 agg 1,000,000 each 1:000,000 agg DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Location of Covered Operations: 1677 W. Ord Way, Anaheim, CA 92802 City of Santa Ana is included as Additional Insured as respects to General Liability per the blanket endorsement form PI-GLD-HA (10/11) attached to the insured's policy. t� CERTIFICATE HOLDER CANCELLATION - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Attention: Community Development Agency 20 Civic Center Plaza (M-25) P.O. Box 1988 AUTHORIZED REPRESENTATIVE Santa Ana CA 92702 ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD