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DATE(MM/DD/YYYY)
<br /> ACOR" CERTIFICATE OF LIABILITY INSURANCE
<br /> `. 01/14/2025
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER NAME CT Lockton Affinity, LLC
<br /> Lockton Affinity, LLC AI_ Ext:800-278-8130 IC,
<br /> No):913-652-7599
<br /> E-MAIL
<br /> P. O. Box 879610 ADDRESS:
<br /> Kansas City, MO 64187-9610 INSURERS AFFORDING COVERAGE NAIC9
<br /> INSURER A:Hartford Underwriters Insurance Company 30104
<br /> INSURED
<br /> INSURER B:Hartford Accident and Indemnity Company 22357
<br /> SIMPLETHERAPY INC. , HALCYON
<br /> INSURERC:
<br /> BEHAVIORAL, LLC
<br /> 6111 South Front Rd. , Suite B INSURERD:
<br /> Livermore CA 94551 INSURERE:
<br /> INSURER F:
<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 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 DDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICYNUMBER MWDDIYW MM/DDIYYY
<br /> A X COMMERCIAL GENERAL LIABILITY X X 37SBAAY4GNC 01/01/2025 01/01/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE FX I OCCUR PREM SES EaENTE occurrence)
<br /> ccuonce $1,000,000
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> X POLICY L—I j�T LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER:
<br /> A AUTOMOBILE LIABILITY 37SBAAY4GNC 01/01/2025 01/01/2026 COMBINED SINGLE LIMIT
<br /> Ea accident $1 000 000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> X X NON-OWNED PROPERTY DAMAGE $
<br /> HIRED AUTOS AUTOS Per accident
<br /> A X UMBRELLA LIAB X OCCUR X X 37SBAAY4GNC 01/01/2025 01/01/2026 EACH OCCURRENCE $6,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $6,000,000
<br /> DED X RETENTION$10 000 $
<br /> B WORKERS COMPENSATION X 37WECAF7PA9-01 01/01/2025 01/01/2026 g SPER TATUTE OERH
<br /> AND EMPLOYERS'LIABILITY Y/N
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICERIMEMBER EXCLUDED? ❑ N I 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 /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Snta Ana is included as an Additional Insured on a primary and non-contributory basis on the General, Auto and Umbrella
<br /> liability policy as required by written contract. A Waiver of Subrogation applies to the City of Santa Ana with respest to the
<br /> General, Auto, and Umbrella policy as required by written contract.
<br /> Tu Tran Durralnysigned Nguyenby APPROVED
<br /> Date:2025.04.09
<br /> Nguyen 14:55:16-07'00'
<br /> By Tu Tran Nguyen at 2:54 pm,Apr 09, 2025
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> 3027968
<br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza
<br /> Santa Ana, CA 92702 AUTHORIZ EPRESENTATIVE
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> 51913682 3027968
<br />
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