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____......."N FAMIFOR-01 RENAS
<br /> '4c'oRo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br /> `..---- 8/6/2024
<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 License#0M10410 CONTACT
<br /> NAME:
<br /> Armstrong!Robitaille/Riegle Bu ' ess and Insurance Solutions PHONE d'-by
<br /> 1500 Quail St,Suite#100 ` e (ANC,No,Eat): :949 Q, • ILL _ I l .C. .s. Cil
<br /> Newport Beach,CA 92660 nigADDRESS:ar.info •I'r-}s • •.w
<br /> I IN UREER((SS)AFFQRDIDING CfQy\ERAGE//��]_ NAIL#
<br /> INSURER A:N .1p Ingle AJ�ijr�eeve 0023
<br /> INSURED INSURER B:! erg Ice met n Indemnity Company 39152
<br /> Families Forward INSURER C Flo a f Lo don 1
<br /> 8 Thomas IN URER : •
<br /> Irvine,CA 9261Aceved
<br /> 0 CRF: Q� �-/A�
<br /> COVERAGES CERTIFICATE NUMBER: _ O J.O 2tavt�'1 Na7 OO
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW;,AVE 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 NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR !NWS1VIL (MM/DD/YYYYJJMMI000I'Y()
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR X 2024-02647 7/1/2024 7/1/2025 PREMISES(Ea occurrence) $ 500,000
<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- X LOC PRODUCTS-COMP/OP AGG $ 3,000,000
<br /> OTHER: LIQUOR LIAB $ 1,000,000
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> (Ea accident) $
<br /> X ANY AUTO 2024-02647 7/1/2024 7/1/2025 BODILY INJURY LPer person) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY _ AUTOS BODILY INJURY LPer accident)_ $
<br /> X AUTOS ONLY X AUTOSS ONE' (Perr accidenTY tDAMAGE $
<br /> $
<br /> A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000
<br /> X EXCESS LIAB CLAIMS-MADE 2024-02647-UMB 7/1/2024 7/1/2025 AGGREGATE $ 2,000,000
<br /> DED X I RETENTION$ 0 $
<br /> B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X STATUTE I ERH
<br /> SATIS0579600 7/1/2024 7/1/2025 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $
<br /> (Mandatoryin NH)EXCLUDED? 1,000,000
<br /> E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A Professional(E&O) 2024-02647 7/1/2024 7/1/2025 Each Occurrence 1,000,000
<br /> C Abuse&Molestation W37D8F240101 7/1/2024 7/1/2025 Aggregate 3,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> The City of Santa Ana,its officers,officials,employees,and volunteers are named as Additional Insured on Primary and Non-Contributory basis with respect
<br /> to General Liability coverage per attached forms as required in a written contract,agreement,or memorandum of understanding. 30 Days Cancellation Notice
<br /> unless 10 Days for Non-Payment.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE City of Santa Ana ACCORDANCE WITH THE POLICY PR(TION DATE THEREO`
<br /> r .tc)
<br /> Risk Management Division �nEWED&APPROVED9v.20 Civic Center Plazar=AUTHORIZED REPRESENTATIVESanta Ana,CA 92702 114.1u Au4,44
<br /> :Romam`meµ /� ' Risk Management Specialist '.
<br /> 1 ✓ MM"""" ----11
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
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