|
A�® CERTIFICATE OF LIABILITY INSURANCE DAT�122�2p SYYY)
<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(li
<br /> PRODUCER CONTACT Ste
<br /> NAME; ven Eddinger
<br /> Kraft Lake Insurance Agency PHONE (423)886-3123 (423)886-317
<br /> AIC No Exi: AIC No
<br /> PO BOX 1426-Loo 1482 A-MPLIL : seddinger@farmersagent.com
<br /> Grand Rapids,MI 49501 INSURER(S)AFFORDING COVERAGE NAIC9
<br /> INSURERA: Philadelphia Insurance Companies 18058
<br /> INSURED INSURER B:
<br /> StandUp For Kids
<br /> INSURER C
<br /> 200 Nelson Ferry Rd INSURER D:
<br /> Ste B INSURER E:
<br /> Decatur GA 30030 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO 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 MAYBE 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 /> LTR TYPE OF INSURANCE D D POLICY NUMBER MMIDDIYYYY MM!DlYYYY LIMITS
<br /> COMMERCIAL GENERAL LIABILITY
<br /> X EACH OCCURRENCE $ 1,000,000
<br /> X CLAIMS-MADE r�'J OCCUR PREMISES Ea occurrent $ 100,000
<br /> A Y Y PHPK2558355-003 07/15/2024 07tl 512025 MFD EXP(Any one person $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> �G/ENL AGGREGATE LIMITAPPLIESPER: GENERALAGGREGATE $ 3,000,000
<br /> POLICY F]PRO- ❑
<br /> JECT LOG PRODUCTS-COMPIOPAGG $ 3,000,000
<br /> OTHER: ABUSIVE CONDUCT LIABILITY $ 1,000,000
<br /> AUTOMOBILE LIABILITY C Ea accidOMBINED SINGLE LIMIT $ 1,000,000
<br /> ent
<br /> ANYAUTO BODILY INJURY(Per person) $
<br /> A OWNED SCHEDULED PHPK2556355-003 07115/2024 07/15/2025 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> XHIRED V NON-OWNED PROPER7YDAMAGE
<br /> AUTOS ONLY /� AUTOS ONLY Per acclden!
<br /> X 08,09 $
<br /> X UMBRELLA LIAB X OCCUR
<br /> EACH OCCURRENCE $ 3,000,000
<br /> * EXCESSLIAB X I CLAIMS-MADE PHUBS66726-003 07/15/2024 07/15/2025 AGGREGATE $ 3,000,000
<br /> DED RETENTION$ 10,000 $
<br /> WORKERS COMPENSATION - PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> YIN E,L,EACHACCIDENT $
<br /> ANY PROPRIMBEIR EXCLUDED?
<br /> IExECUTIVE
<br /> OFFICERIMEMBER EXCLUDED?
<br /> (Mandatory in NH) F.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $
<br /> Professional Liability PHPK2558355.003 07/15/2024 07J1512025 Each Professlonal Inoidenl Limit $ 1,000,000
<br /> A Aggregate Limit $ 3,000,000
<br /> Oyber Liability PHSD1841273-001 11/22/2024 11/2212025 Aggregate Limit $ 1,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) -
<br /> "City of Santa Ana,its City Council,its officers,officials,employees,agents,and volunteers are named as additionally insured on this policy
<br /> pursuant 10 written contract,agreement,or memorandum of understanding.Such insurance as is afforded by this policy shall be primary,and any
<br /> insurance carried by City shall be excess and noncontributory."
<br /> Certificate holder is an"Additional Insured"per the General Liability Deluxe Endorsement:Human Services(PI-GLD-HS)form attached to the policy.
<br /> 30-Days Notice of Cancellation,except for Non-Payment which is 10-Days Notice,.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Attn:Mishaun Watkins THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> 20 Civic Center Plaza nigitallyslgned ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Santa Ana,CA 92702 TU Tr an it guyenan
<br /> Nguyen ld:2025.DUD AUTHORIZED REPRESENTATIVE
<br /> 01988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
|