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Digitally signed by Francine R.
<br />Francine R. Villareal Villareal
<br />Date: 2021.06.30 16:56:27-07'00'
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<br />A� " CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />5/25/2021
<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 />(OC) Heffernan Insurance Brokers
<br />18004 Sky Park Circle, Suite 210
<br />Irvine CA 92614
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />A/C No Ext: 949-771-3400 A/c,No:949-771-3401
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Nonprofits Insurance Alliance of California
<br />1184
<br />License#: 0564249
<br />INSURED HUMAOPT-04
<br />Human Options, Inc.
<br />PO Box 53745
<br />INSURER B : Lloyd's of London
<br />INsuRERc: Service American Indemnity Company
<br />39152
<br />INSURERD:
<br />Irvine CA 92619
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 1479360323 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />202001143
<br />9/23/2020
<br />9/23/2021
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGES(RENTED
<br />PREMISES Ea occurrence)$
<br />500,000
<br />MED EXP (Any one person)
<br />$ 20,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />POLICY ❑ PRO
<br />JECT LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 3,000,000
<br />Sexual Misconduct
<br />$ 1,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />202001143
<br />9/23/2020
<br />9/23/2021
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />202001143UMB
<br />9/23/2020
<br />9/23/2021
<br />EACH OCCURRENCE
<br />$5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ n
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />SATISO427000
<br />4/1/2021
<br />4/1/2022
<br />X PER OTH-
<br />STATUTE ER
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />B
<br />Cyber Liability
<br />ESI0119140663
<br />6/20/2020
<br />9/23/2021
<br />Limit
<br />1,000,000
<br />A
<br />Sexual Misconduct
<br />202001143
<br />9/23/2020
<br />9/23/2021
<br />Limit
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Re: As Per Contract or Agreement on File with Insured.
<br />The City of Santa Ana, Risk Management, its officers, employees, agents, representatives and volunteers are included as an additional insured (primary and
<br />non-contributory) on General Liability policy per the attached endorsement, if required. 30 day Notice of Cancellation applies. $5M Umbrella policy goes over
<br />the underlying General Liability, Automobile Liability, Workers' Compensation, and Sexual Misconduct Policies.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL
<br />BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th floor
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702
<br />�
<br />�
<br />Risk MallagementDEBY
<br />REVIEWED &APPROVED BY.-
<br />© 1988-2015 ACORD C
<br />z
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />'
<br />Risk Management Analyst
<br />
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