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A`"R" CERTIFICATE OF LIABILITY INSURANCE EX E(M D/YYYY)
<br /> 5/30/2025
<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 CONTACT Steven Eddinger
<br /> NAME:
<br /> Kraft Lake Insurance Agency PHONE
<br /> Ext: (423)886-3123 /X No: (423)886-317
<br /> PO BOX 1426-Loc 1482 E-MAIL seddinger@farmersagent.com
<br /> ADDRESS:
<br /> Grand Rapids,MI 49501 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: Philadelphia Insurance Companies 18058
<br /> INSURED
<br /> INSURER B
<br /> StandUp For Kids INSURER C:
<br /> 200 Nelson Ferry Rd INSURER D:
<br /> Ste B
<br /> INSURER E
<br /> Decatur GA 30030 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFYTHAT 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 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 /> INSR TYPE OF INSURANCE ADDL UBR POLICY NUMBER MM/DD YYYYMMIDD Y YY LIMITS
<br /> POLICY EFF POLICY EXP
<br /> LTR INSD WVD
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE X CLAIMS-MADE �OCCUR PREM'EMI,
<br /> occur«Dance $ 100,000
<br /> A Y Y PHPK2558355-003 07/15/2024 07/15/2025 MED EXP(Any one person) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 3,000,000
<br /> X PRO ❑ 3,000,000
<br /> POLICY ElJECT LOC PRODUCTS-COMP/OPAGG $
<br /> OTHER: ABUSIVE CONDUCT LIABILITY $ 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br /> Ea accident $ 1,000,000
<br /> ANYAUTO BODILY INJURY(Per person) $
<br /> A OWNED SCHEDULED PHPK2558355-003 07/15/2024 07/15/2025 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED H
<br /> NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> X 08,09 $
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000
<br /> A EXCESS LIAB X I CLAIMS-MADE PHUB865726-003 07/15/2024 07/15/2025 AGGREGATE $ 3,000,000
<br /> DED I I RETENTION$ 10,000 $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If Ves,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> Professional Liability PHPK2558355-003 07/15/2024 07/15/2025 Each Professional Incident Limit $ 1,000,000
<br /> A Aggregate Limit $ 3,000,000
<br /> Cyber Liability PHSD1841273-001 11/22/2024 11/22/2025 Aggregate Limit $ 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/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, and volunteers are named as additionally insured on this
<br /> policy pursuant to written contract, agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be
<br /> primary,and any 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 /> Attention:Audrey Goodson THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> 801 W Civic Center Drive,Suite 200 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Santa Ana,CA 92701
<br /> AUTHORIZED REPRESENTATIVE
<br /> APPROVED �&- � c
<br /> By Tu Tran Nguyen at 9:52 am,Jun 03,2025
<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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