|
CERTIFICATE OF LIABILITY INSURANCE I DATE 41/202/1/202YYYrI
<br />4
<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 endorsementfsl.
<br />PRODUCER
<br />(OC) Heffernan Insurance Brokers
<br />18004 Sky Park Circle, Suite 210
<br />Irvine CA 92614 A
<br />INSURED
<br />Human Options,
<br />PO Box 53745
<br />Irvine CA 92619
<br />COVERAGES
<br />At L
<br />THIS IS TO CERTIFY OLICI S C LO E "IS...
<br />ISSI U�EDTOjT�H�E INMS�LtfR�rE�yD-�N1'A1rMkl�ED AB/Or'rV��EFOR THE PERIOD
<br />rI Y UIR OR DI F �P�rO-t�L`I"CLY' CH THIS
<br />CERT FICATE MAY ISSU Y IN, E71N C .iD 7HEO PpLFIgS QE/Cf�BEI� I-kHeYVN IB.077 l{� ML .HE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN L,AY',AVE BEEN REDUCEDDYPAIb'CWIMB. VV ��J// V vVV VVV
<br />INSR
<br />LTR
<br />OF INSURANCE
<br />ADDILTYPE
<br />J=SUBR
<br />POLICYNUMBER
<br />MMI���
<br />MM/UO EXP
<br />LIMITS
<br />B
<br />X
<br />COMMERCUILGENERAL LIABILITY
<br />Y
<br />010041350
<br />9/23/2023
<br />9/23/2024
<br />EACH OCCURRENCE
<br />$1.000.000
<br />CLAIMS -MADE OCCUR
<br />DAMA ESTO (RENTED
<br />PREMISES (Ea occurrence)
<br />$7,000,000
<br />IVIED EXP(Any one person)
<br />$20,000
<br />PERSONALBADV INJURY
<br />$1.000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$3.000,000
<br />%t POLICY JECT LOC
<br />PRODUCTS-COMP/OP AGO
<br />$3,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />010041351
<br />9/23/2023
<br />9123,2024
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />BODILY I NJURY(Per person)
<br />$
<br />AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />IANY
<br />BODILY I NJURY(Par accident)
<br />$
<br />XIHIRED
<br />PROPERTY DAMAGE
<br />Per accld ei
<br />$
<br />X ON N'WNEO
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />010041352
<br />9/23/2023
<br />9/23/2024
<br />EACHOCCURRENCE
<br />$5,000,000
<br />AGGREGATE
<br />$5,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED I X I RETENTION$ ft
<br />1
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY Y/N
<br />01-0037-245
<br />4/1/2024
<br />4/1/2025
<br />X 11 PER O7H-
<br />STATUTE ER
<br />ANWROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />OFFICER/MEMBEREXCLUDED? ❑
<br />NIA
<br />E.L. DISFASE-EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS be.
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000, DOD
<br />B
<br />Professional Liability
<br />010041350
<br />9/23/2023
<br />9/23/2024
<br />Per Claim Limit
<br />1,000,000
<br />B
<br />C
<br />Employee Dishonesty
<br />Cyber Liability
<br />1 010041350
<br />H23NGP210733-02
<br />9/23/2023
<br />9/23/2023
<br />9/23/2024
<br />9/23/2024
<br />Per Location Limit
<br />Each Claim Limit
<br />500.000
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Re: As Per Contract or Agreement on File with Insured. The City of Santa Ana, Risk Management, its officers, employees, agents, representatives and
<br />volunteers are included as an additional insured (primary and non-contributory) on General Liability policy per the attached endorsements, if required. 30 day
<br />Notice of Cancellation applies. $5M Umbrella policy goes over the underlying General Liability, Automobile Liability, Workers' Compensation, and Sexual
<br />Misconduct Policies.
<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 ACCORDANCE WITH THE POLICY PRC
<br />Risk Management Division y'b WdeMaaagnnod.Dlvielon
<br />20 Civic Center Plaza, 4th floor AUTHORIZED REPRESENTATIVE ;max-� .. REvii & APPROVED, BY:
<br />Santa Ana, CA 92702
<br />Risk Management SpedBlitt
<br />©1988-2015 ACORD ol
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|