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AC"Rbr CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDIYYYY) <br />IiN.� <br />5/27/2025 <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($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ios) 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 <br />Arthur J. Gallagher Risk Management Services, LLC <br />18201 Von Karman Ave <br />COW" <br />Julie Fernandez E. <br />PHONE FAx <br />• 949-349.9821 AIc NO: 949-349-9967 <br />Suite 200 <br />Irvine CA 92ti 12 <br />F-MAILss: Julie Fernandez@ajg.com <br />INSURERS AFFORDING COVERAGE <br />NAIL N <br />INSURER A: Wesco Insurance Company <br />25011 <br />License* oDs9293 <br />INSURED THOMHOU-D2 <br />Thomas House Temporary Shelter <br />PO Box 2737 <br />INSURER B : Service American Indemnity Company <br />39152 <br />INSURER C: Security National Insurance Company <br />19879 <br />INSURER o: Arch Insurance Company <br />11150 <br />Garden Grove CA 92842 <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 2279R6gR7 Pr-VICIAM 1dIIMi3C0& <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 />EXCLJSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />POLICY EPP <br />MMIDDIYYYY <br />POLICY EXP <br />MMMDfYYYY <br />LIMITS <br />C <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE X OCCUR <br />Y <br />Y <br />SPP1821824 <br />10/3/2024 <br />10/3/2025 <br />EACH OCCURRENCE <br />$1,000,000 <br />DAMAGE 0E TED <br />PREMISES fEa occurrence <br />$ 100.000 <br />MED EXP (Any one parson) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />PRO- <br />POLfCY JECT LOC <br />GENERAL AGGREGATE <br />$ 3,000,000 <br />GEN'L <br />X <br />PRODUCTS -CCMPIOPAGG <br />$3,000,00o <br />$ <br />OTHER: <br />C <br />AUTOMOBILE <br />LIABILITY <br />Y <br />Y <br />SPP1822767 Oo <br />10/3/2024 <br />10l3/2025 <br />0Q QBI ot51NGLE LIMIT <br />$1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />HIRED X NON -OWNED <br />AJTOS ONLY AUTOS ONLY <br />XI$ <br />PROPERTY DAMAGE <br />par accident <br />$ <br />A <br />X <br />UMBRELI.ALIAB <br />X <br />OCCUR <br />Y <br />Y <br />WUM182911805 <br />10/3/2024 <br />10/3/2025 <br />EACH OCCURRENCE <br />$1,000,000 <br />AGGREGATE <br />$1,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I X I RETENTION $ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANYPRCPRIETOP4PARTNERIEXECUTIVE <br />OFFICERIMEMBEREXCLUDED? El <br />NIA <br />SATIS0344904 <br />10/1/2024 <br />10/112025 <br />X STATUTE aTRN <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1.000,000 <br />(Mandatory In NH) <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />DESCRIPTION OF OPERATIONS below <br />C <br />C <br />O <br />SocdaE Services Prof. Liab/E&O <br />SexualvePhysicalAbuse <br />Executive Package -See below <br />SPP1821824 <br />SPP1821824 <br />NFP012112208 <br />10l312024 <br />10/3/2024 <br />11/23l2024 <br />101312025 <br />1013l2025 <br />11/23/2025 <br />Each IncidenllAgg <br />EachIncidentlAgg <br />$1 M ! $3M <br />$1M/$3M <br />DESCRIPTION OF OPERATIONS l LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) <br />Executive Package - 11/23/2024-11123/2025 Policy #NFP012112207 DigltallysIgned <br />Director &Officers & Employment Practices Liability: TU Tran byTeTran <br />Limit of Liability: $1,000,000 Deductible $5,000 rg yen <br />N g uyeh aatt Ze25.e6.24 <br />Fiduciary: 15110-e7ac <br />Limit of Liability: $260,000 Deductible $0 <br />City of Santa Ana, Attention: Community Development Agency, Homeless Services, 20 Civic Center Plaza, M25 Santa Ana, CA 92701 are lisred as additional <br />insured <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attention: Community Development Agency, Homeless <br />20 Civic Center Plaza, M25 AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92702 - <br />(0 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />