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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />01/10/2025
<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 />CONTACT Mary Strohman
<br />NAME:
<br />KesslerAlair Insurance Services, Inc
<br />(909) 931-1500 q/c, (909) 932-2133
<br />A//CC'
<br />Ext : No :
<br />License # OA 91387
<br />E-MAIL mstrohman@kessleralair.com
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />12487 N. Mainstreet, Ste. 240
<br />Rancho Cucamonga CA 91739
<br />INSURERA: Philadelphia Insurance
<br />18058
<br />INSURED
<br />INSURER B : Employers Preferred Ins Co
<br />11512
<br />Revenue & Cost Specialists, LLC
<br />INSURER C :
<br />1519 E. Chapman Ave., Suite C
<br />INSURER D :
<br />INSURER E :
<br />Fullerton CA 92831-4013
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 24-25 GL, XS, WC 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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 />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE FX OCCUR
<br />PREM SES Ea occurDrence
<br />$ 500,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />Y
<br />PHBX20001810
<br />12/31/2024
<br />12/31/2025
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />X POLICY ❑ PECT ❑ LOC
<br />PRODUCTS-
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />PHBX20001810
<br />12/31/2024
<br />12/31/2025
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED �/ NON -OWNED
<br />AUTOS ONLY /� AUTOS ONLY
<br />X
<br />UMBRELLA LAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X
<br />AGGREGATE
<br />$ 1,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />PHUB887768-016
<br />12/31/2024
<br />12/31/2025
<br />DED I X1 RETENTION $ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N/A
<br />EIG2980142-05
<br />12/31/2024
<br />12/31/2025
<br />PER
<br />X1 STATUTE EORH
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE- EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />1,000,000
<br />$
<br />A
<br />Professional Liability
<br />Retro Date - 04/27/1990
<br />PHSD1849273
<br />12/31/2024
<br />12/31/2025
<br />Aggregate Limit
<br />2,000,000
<br />Per Claim
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Additional Insured is City of Santa Ana Human Resources Department, its officers, officials, employees, or volunteers, per endorsement attached, waiver of
<br />subrogation and primary & non-contributory applies per endorsements attached.
<br />APPROVED
<br />By Cynthia Mora at 4:14 pm, Jan 15, 2025
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana Human Resources Department
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701
<br />© 1988-2015ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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