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SANUItU-19 <br />ORTP <br />DATE110/8/ 024 <br />10/8/2024 <br />,acoRO` CERTIFICATE OF LIABILITY INSURANCE <br />`—� <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 endorsements . <br />PRODUCER <br />Fusco & Orsini Insurance Services, Inc. <br />5095 Murphy Canyon Road, Suite 200 <br />San Diego, CA 92123 <br />CONTACT <br />AME: <br />jalcD, ao, Ezt: (858) 384-1506 (AIC No :(800) 209-9298 <br />EbMAriEss: service@foagency.com <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURER A: Philadelphia Indemnity Ins. Co. <br />18058 <br />INSURED <br />INSURER B:SirluS oint America Insurance Company <br />38776 <br />INSURER C: <br />San Diego Centre For Organization Effectiveness <br />INSURER D <br />3914 Murphy Canyon Rd #A164 <br />San Diego, CA 92123 <br />INSURER E <br />NSURERF: <br />COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 <br />TYPE OF INSURANCE <br />ADDLSUBR INSD <br />MD <br />POLICY NUMBER <br />POLICYEFF <br />POLICYEXPLTR <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE X OCCUR <br />X <br />X <br />PHPK2619252 <br />12/712023 <br />121712024 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence) <br />100,000 <br />$ <br />MED EXP (Any oneperson) <br />$ 5,000 <br />PERSONAL&ADV INJURY <br />$ 1,000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY JECT LOC <br />GENERAL AGGREGATE <br />$ 2,00%000 <br />GEHL <br />X <br />PRODUCTS - COMP/OP AGG <br />$ 2,000,000 <br />% <br />OTHER: <br />APOMOBILE <br />LIABILITY <br />EOMBINdEED SINGLE LIMIT rU <br />$ 1,000,000 <br />BODILY INJURY Par person)$ <br />ANY AUTO <br />X <br />X <br />PHPK2619252 <br />121712023 <br />121712024 <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY Peracckhst <br />$ <br />PeOacc tlent AMAGE <br />$ <br />ALKYDS ONLY X AUT09 ONLB <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />YIN <br />OFFICERMIEMBDER EXCLUDED ECUTIVE <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />WC72861000 <br />7211012023 <br />1211012024 <br />X PER OTH- <br />STATUTE ER <br />EL EACH ACCIDENT <br />1,000,000 <br />$ <br />E.L. DISEASE -EA EMPLOYEE <br />$ 1,000,000 <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />A <br />Professional Liab <br />PHPK2619252 <br />121712023 <br />121712024 <br />Aggregate Limit <br />2,000,000 <br />A <br />Professional Liab <br />PHPK2619252 <br />1217/2023 <br />121712024 <br />Each Incident <br />1,000,000 <br />DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) <br />City of Santa Ana, its City Council, its officers, officials, employees, agents, & volunteers are named as additional insured per endorsement on gGL CG2037 <br />(04113). Primary wording PI-GL-005 (7112) and waivers of subrogation apply to the general liability. Additional insured & Primary wording apply per PI-Mani-1 <br />(1100) with waiver of subrogation per CA04444 (3110) to the BA. 30 Cancellation applies to the GL & BA. Waiver of subrogation applies to the Workers <br />Compensation. <br />APPROVED <br />By Cynthia Mora at 12:55 pm, Nov 26, 2024 <br />CERTIFICATE HOLDER <br />CANCELL <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Cityof Santa Ana <br />20 Civic Center Plaza <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />'CvltY) <br />ACORD 25 (2016103) @ 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />