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
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