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74/17/2025
<br /> (MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE
<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: Brandon FUII
<br /> CalNonprofits Insurance Services PHONE FAX
<br /> 1500 41 st Avenue, Suite 228 A/C No Ext: 831-824-5020 A/c,No:831-462-8529
<br /> Capitola CA 95010 ADDRESS: brandon@cal-insurance.org
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: Philadelphia Indemnity Insurance Company 18058
<br /> INSURED OCHUMAN-01 INSURER B: Hartford Casualty Insurance Company 29424
<br /> We Are Groundswell
<br /> 1801 E Edinger Ave, Ste. 115 INSURER C: Underwriters at Lloyds, London
<br /> Santa Ana CA 92705 INSURER D:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:826169549 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 I POLICY NUMBER MM/DD/YYYY MM/DDIYYYY
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y PHPK2664706-020 4/26/2025 4/26/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED
<br /> PREMISES Ea occurrence $100,000
<br /> MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY PRO- LOC PRODUCTS-COMP/OP AGG $1,000,000
<br /> JECT
<br /> OTHER:El $
<br /> A AUTOMOBILE LIABILITY PHPK2664706-020 4/26/2025 4/26/2026 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 PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> A X UMBRELLA LIAB X OCCUR PHUB903790-002 4/26/2025 4/26/2026 EACH OCCURRENCE $2,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000
<br /> DED X RETENTION$in ono $
<br /> B WORKERS COMPENSATION Y 57WECANlML1 10/1/2024 10/1/2025 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? NIA
<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 /> C Cyber Liability ESN0240143583 12/15/2024 12/15/2025 Policy Aggregate $1,000,000
<br /> A Professional Liability PHPK2664706-020 4/26/2025 4/26/2026 Each Occ./Aggregate $1 M/$2M
<br /> A Improper Sexual Conduct&Abuse PHPK2664706-020 4/26/2025 4/26/2026 Each Occ./Aggregate $1 M/$2M
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Santa Ana,its City Council,officers,officials, employees,agents,and volunteers are included as Additional Insured with respect to General Liability as
<br /> required by written contract per Endorsement Form(s)CIS 20 26 04 13 and PI-GL-005(07/12)attached.General Liability coverage is Primary&
<br /> Non-Contributory and Waiver of Subrogation applies as required by written contract per Endorsement Form(s)PI-GL-005(07/12)&PI-GLD-HS(10/11)
<br /> attached.Worker's Compensation Waiver of Subrogation applies as required by written contract per Endorsement Form(s)WC 99 00 06 B attached.
<br /> Digitally signed
<br /> Tu Tran y yy an
<br /> N guyen APPROVED
<br /> N
<br /> NgUy2n Date:z5-07'00' g Tu Tran Nguyen at 11:46 am,Apr 18,2025
<br /> n:a�:as-o.0roo Yp
<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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> City of Santa Ana
<br /> 20 Civic Center Plaza AUT IZEDREPRESENTATIVE
<br /> Santa Ana CA 92701
<br /> @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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