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DATE(MM/DD/YYW)
<br /> A`oRo° CERTIFICATE OF LIABILITY INSURANCE 9/20/2024
<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 holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME:
<br /> (OC) Heffernan Insurance Brokers PHONE FAX
<br /> 18004 Sky Park Circle, Suite 210 A/C No Ext: 949-771-3400 vc,No:949-771-3401
<br /> E-MIrvine CA 92614 ADDRESS: hibcertrequest@heffins.com
<br /> INS ER(S).AFFORDIN lCffERAW NAIC#
<br /> License#:0564011.SURERDat
<br /> SUR'-R pe� I r n luny 14559
<br /> INSURED �/'� � I /'� Acleve
<br /> z � � tual Insurance Company 15032
<br /> Human Options, Inc. ' IC Rc, �,iston asualty Company 42374
<br /> PO Box 53745
<br /> Irvine CA 92619 — 100
<br /> 1
<br /> F
<br /> INSURER E:
<br /> INSURER F
<br /> COVERAGES CERTIFICATE NUMBER:1756922177 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICYNUMBER MM/DD MM/DD
<br /> B X COMMERCIAL GENERAL LIABILITY Y 01-0041-350 9/23/2024 9/23/2025 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE OCCUR PREMISES TO ccED
<br /> PREMISES Ea occurrence) $1,000,000
<br /> MED EXP(Any one person) $20,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000
<br /> POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG $3,000,000
<br /> X El JECT
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY 01-0041-351 9/23/2024 9/23/2025 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON-OWNED FIR ERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> A X UMBRELLALIAB X OCCUR 01-0041-352 9/23/2024 9/23/2025 EACH OCCURRENCE $5,000,000
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED X RETENTION$ $
<br /> A WORKERS COMPENSATION 01-0037-245 4/1/2024 4/1/2025 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? ❑ N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> B Professional Liability 01-0041-350 9/23/2024 9/23/2025 Per Claim Limit 1,000,000
<br /> B Employee Dishonesty 01-0041-350 9/23/2024 9/23/2025 Per Location Limit 500,000
<br /> C Cyber Liability H24NGP210733-03 9/23/2024 9/23/2025 Each Claim Limit 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be 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 /> CERTIFICATE HOLDER 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 ACCORDANCE WITH THE POLICY PRC
<br /> Risk Management Division RiskMamgementDMs[an
<br /> 20 Civic Center Plaza, 4th floor AUTHORIZED REPRESENTATIVE REVIEWED&PaPPROVmBy.
<br /> Santa Ana, CA 92702 / A Aczt,44
<br /> I®,
<br /> Risk Management Specialist
<br /> ©1988-2015 ACORD
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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