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ACORO® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />��
<br />01/14/2025
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />NAME CT Lockton Affinity, LLC
<br />Lockton Affinity, LLC
<br />A/ONNo Ext:800-278-8130 A/C,No:913-652-7599
<br />E-MAIL
<br />P. O. Box 879610
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />Kansas City, MO 64187-9610
<br />INSURERA: Hartford Underwriters Insurance Company
<br />30104
<br />INSURED
<br />INSURER B: Hartford Accident and Indemnity Company
<br />22357
<br />SIMPLETHERAPY INC., HALCYON
<br />BEHAVIORAL, LLC
<br />INSURER C
<br />INSURERD:
<br />6111 South Front Rd., Suite B
<br />INSURERE:
<br />Livermore CA 94551
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 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/YYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />X
<br />X
<br />37SBAAY4GNC
<br />01/01/2025
<br />01/01/2026
<br />EACH OCCURRENCE
<br />$ 1 , 000 , 000
<br />CLAIMS -MADE X OCCUR
<br />7-1
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2 , 000 , 000
<br />POLICY PRO ❑ LOC
<br />JECT
<br />X
<br />PRODUCTS- COMP/OP AGG
<br />$ 2 , 000 , 000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />37SBAAY4GNC
<br />01/01/2025
<br />01/01/2026
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />ALLOWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />X NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />X
<br />X
<br />37SBAAY4GNC
<br />Ol/O7/2025
<br />O7/Ol/2026
<br />EACH OCCURRENCE
<br />$ 6, 000 , 000
<br />AGGREGATE
<br />$ 6, 000 , 000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ 10 000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />X
<br />37WECAF7PA9-01
<br />01/01/2025
<br />01/01/2026
<br />X STATUTE 01RH
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$ 1 , 000 , 000
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />N / A
<br />E.L. DISEASE - EA EMPLOYE
<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 $ 1 , 000 , 000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (AOORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Snta Ana is included as an Additional Insured on a primary and non-contributory basis on the General, Auto and Umbrella
<br />liability policy as required by written contract. A Waiver of Subrogation applies to the City of Santa Ana with respest to the
<br />General, Auto, and Umbrella policy as required by written contract.
<br />Tu Tra n Tu Tralnysigned Nguyen by
<br />Date: 2025.04.09 APPROVED
<br />Nguyen
<br />14:55:16-0T00'
<br />By Tu Tran Nguyen at 2:54 pm, Apr 09, 2025
<br />CERTIFICATE HOLDER CANCELLATION
<br />3027968
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Risk Management Division
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />AUTHORIR�N� I
<br />��I_'Z
<br />Santa Ana, CA 92702
<br />ACORD 25 (2014101)
<br />51913682
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />3027968
<br />
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