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DATE(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE 9/25/2025
<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 CONTACT
<br /> NAME: Brandon Fujii
<br /> CalNonprofits Insurance Services PHONE FAX
<br /> 1500 41 st Avenue, Suite228 A/C No EXt: 831-824-5020 A/c,Noy 831-462-8529
<br /> E-MCapitola CA 95010 ADDRESS: brandon@cal-insurance.org
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: Philadelphia Indemnity Insurance Company 18058
<br /> INSURED OCHUMAN-01 INSURERB: Hartford Casualty Insurance Company 29424
<br /> We Are Groundswell
<br /> 1801 E Edinger Ave, Ste. 115 INsuRERc: Underwriters at Lloyds, London
<br /> Santa Ana CA 92705 INSURERD:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1092785883 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 POLICY NUMBER MM/DD MM/DD
<br /> A X COMMERCIAL GENERAL LIABILRY Y Y PHPK2664706-020 4/26/2025 4/26/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE � OCCUR PREMISES DAMAGE TO
<br /> PREMISES Ea occurrence)
<br /> ccurrence $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 D PRO ❑
<br /> JECT LOC PRODUCTS-COMP/OP AGG $1,000,000
<br /> OTHER: $
<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 FIR ERTYDAMAGE $
<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$1 n nnn $
<br /> B WORKERS COMPENSATION Y 57WECAN1ML1 10/1/2025 10/1/2026 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICE R/M EMBER 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 /> 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 $1M/$2M
<br /> A Improper Sexual Conduct&Abuse PHPK2664706-020 4/26/2025 4/26/2026 Each Occ./Aggregate $1M/$2M
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> Accident(Philadelphia Indemnity Insurance Company, NAIC#18058, Policy#PHPA157428-006,5/10/2025-5/10/2026, Maximum Benefit:$100,000)
<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)CG 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 00 03 13 attached.
<br /> APPROVED
<br /> CERTIFICATE HOLDER By Tu Tran Nguyen at 8:37 am,Sep 29,2025 CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Digitally signed ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> City of Santa Ana TU Trap by Tu Tran
<br /> 20 Civic Center Plaza Nguyen
<br /> Santa Ana CA 92701 Nguyen Date:2025.09.29 AUTHORIZED REPRESENTATIVE
<br /> 08:38:23-07'00' y_ �7
<br /> �� I
<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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