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ACOR" CERTIFICATE OF LIABILITY INSURANCE
<br />`�
<br />DATE(MM/DD/YYYY)
<br />1 10/27/2025
<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(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(s).
<br />PRODUCER
<br />Arthur J. Gallagher Risk Management Services, LLC
<br />2050 Main Street
<br />1250
<br />CONTACT
<br />NAME: Chloe Huckabay
<br />PHONE FAX
<br />A/C No EXt: 559-635-3559 A/c,No:
<br />E-MSuite
<br />ADDRESS: Chloe Huckaba a'
<br />_ Y@ 19.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />Irvine CA 92614
<br />INSURERA: Wesco Insurance Company
<br />25011
<br />License#:OD69293
<br />INSURED THOMHOU-02
<br />INSURERB: Service American Indemnity Company
<br />39152
<br />Thomas House Temporary Shelter
<br />PO Box 2737
<br />INSURERC: Security National Insurance Company
<br />19879
<br />INSURERD: Arch Insurance Company
<br />11150
<br />Garden Grove CA 92842
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:731591517 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />C
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />WPP2087817
<br />10/3/2025
<br />10/3/2026
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE � OCCUR
<br />PREMISES DAMAGE TO
<br />ccurrence
<br />PREMISES Ea occurrence)
<br />$ 100,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />POLICY PRO ❑
<br />JECT LOC
<br />X
<br />PRODUCTS - COMP/OP AGG
<br />$ 3,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />SPP1822767 01
<br />10/3/2025
<br />10/3/2026
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<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 />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />WUM1829118 06
<br />10/3/2025
<br />10/3/2026
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ 1 n nnn
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />Y
<br />SATIS0344905
<br />10/1/2025
<br />10/1/2026
<br />X PER OTH-
<br />STATUTEI ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICE R/MEMBER EXCLUDED? ❑
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />Social Services Prof. Liab/E&O
<br />WPP2087817
<br />10/3/2025
<br />10/3/2026
<br />Each Incident/Agg
<br />$1M / $3M
<br />C
<br />D
<br />Sexual or Physical Abuse
<br />Executive Package- See below
<br />WPP2087817
<br />NFP012112208
<br />10/3/2025
<br />11/23/2024
<br />10/3/2026
<br />11/23/2025
<br />Each Incident/Agg
<br />$1M / $3M
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Executive Package - 11/23/2024-11/23/2025 Policy #NFP012112208
<br />Director &Officers & Employment Practices Liability: Digitally signed by APPROVED
<br />Limit of Liability: $1,000,000 Deductible $5,000 Tu Tran TuTran Nguyen
<br />By Tu Tran Nguyen at 8:19 am, Nov 04, 2025
<br />Nguyen Date: 39 5.11.04
<br />Fiduciary: osa9s9-os'oo'
<br />-08 00'
<br />Limit of Liability: $250,000 Deductible $0
<br />City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers are included as Additional Insured as respects General Liability and
<br />Auto Liability policies, pursuant to and subject to the policy's terms, definitions, conditions and exclusions. Waiver of Subrogation applies to (CH/AI entities) as
<br />See Attached...
<br />CERTIFICATE HOLDER CANCELLATION
<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
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attention: Community Development Agency, Homeless
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza, M25
<br />Santa Ana CA 92701
<br />D.
<br />L�---_V e �-7
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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