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ACCORD® CERTIFICATE OF LIABILITY INSURANCE
<br />`....��
<br />DATE(MM/DD/YYYY)
<br />2/28/2024
<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 h der in lieu of s c endorsement(s).
<br />D Y
<br />8 0 �7i Dr. #105 Acevedo
<br />Plano, 75024
<br />Date. 2024.03.14
<br />ac i
<br />crystal Wellborn
<br />A/C N Ext : 205-414-8100 FAX No
<br />ADDE-MARESS:/ Cr stal.wellborn@cacspecialty.com
<br />09:46.05SURER(S)AFFORDING COVERAGE
<br />NAIC#
<br />INSURERA: Everest National Insurance Company
<br />10120
<br />INSURED
<br />CathyJon Enterprises Inc.
<br />DBA HB Staffing
<br />7711 Center Avenue, Suite670
<br />Huntington Beach CA 92647
<br />INSURERB: Everest Indemnity Insurance Company
<br />10851
<br />INSURERC: StarNet Insurance Company
<br />40045
<br />INSURERD: Trisura Specialty Insurance Company
<br />16188
<br />INSURER E7
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 78862138 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 />COMMERCIAL GENERAL LIABILITY
<br />✓
<br />91ML002518241
<br />3/1/2024
<br />3/1/2025
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE IV/] OCCUR
<br />DAMAGE TO RETED
<br />PREMISES(Ea occurrrence)$
<br />200,000
<br />✓
<br />MED EXP (Any one person)
<br />$10,000
<br />Professional Liab (Ded: $5K)
<br />Limits: $1 M Occ/$5M Agg
<br />✓
<br />Emp Practices Liab (Ded: $25K)
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />Limits: $1 M Occ/$2M Agg
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$3,000,000
<br />POLICY ❑PRO- JECT ❑ LOC
<br />✓
<br />PRODUCTS - COMP/OP AGG
<br />$ 3,000,000
<br />OTHER: Fire Legal Liabilit
<br />Limits: $200,000
<br />✓
<br />Abuse or Molestation
<br />$1,000,000
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />✓
<br />91ML002518241
<br />3/1/2024
<br />3/1/2025
<br />C(EaOMBINEDSINGLE$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />✓
<br />PR E
<br />Peorr acdenDAMAGE
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY ✓ AUTOS ONLY
<br />Alternate Employer Endt
<br />$
<br />included
<br />B
<br />�/
<br />UMBRELLALIAB
<br />�/
<br />OCCUR
<br />91CUN00401241
<br />3/1/2024
<br />3/1/2025
<br />EACH OCCURRENCE
<br />$2,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />(Follows Form)
<br />AGGREGATE
<br />$2,000,000
<br />DED RETENTION $
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />OF ICER/MEMBEREXCLUDED? ECUTIVE ❑N
<br />N/A
<br />KEY0145812
<br />KEY0162432 (CA)
<br />1/1/2025
<br />1/1/2026
<br />�/ SPER TATUTE OERH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<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 />A
<br />Crime (including Employee Theft)
<br />91CR001299241
<br />3/1/2024
<br />3/1/2025
<br />Occ&Agg/Deductible $1,000,000/$10,00
<br />D
<br />Cyber Liability
<br />ATB662537602
<br />10/1/2023
<br />10/1/2024
<br />Occ&Agg/Deductible $5,000,000/$25,00
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Contract # A-2018-147. The City of Santa Ana, its officers, employees, agents, and representatives are named as additional insured as respects
<br />to General and Auto Liability. The City of Santa Ana shall be given 30 days written notice of cancellation. Insurance afforded is primary and
<br />non-contributory. Separation of Insured endorsement. "All Owned Auto" does not apply as the insured does not own any company autos and there is
<br />no exposure for their type of operations.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana Risk Management Department
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PRC
<br />oR.N a RA ManagementDMstan
<br />AUTHORIZED REPRESENTATIVE zI f ,°x RWLNVED & PaPPROVm BY:
<br />4d�xl W Afg
<br />I
<br />Aezv
<br />Crystal Wellborn � R Disk Management Specialist
<br />ACORD 25 (2016103)
<br />© 1988-2015 ACORD V
<br />The ACORD name and logo are registered marks of ACORD
<br />78862138 24-25 CathyJon Ent I Crystal Wellborn 12/28/2024 7:46:01 PM (CST) Page 1 of 16
<br />This certificate cancels and supersedes ALL previously issued certificates.
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