|
A11 I7®
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE{MMIDD YYYY)
<br /> 12/20/2024
<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 Certificate Issuance Team
<br /> NAME:
<br /> Comprehensive Insurance Services HCONf� Exit: (949)709-8800 (FAX No
<br /> 26429 Rancho Parkway South EMAIL Jeremy@thecomprehensiveinsurance.com
<br /> ADDRESS:
<br /> Suite 120 INSURER(5)AFFORDING COVERAGE NAIC#
<br /> Lake Forest CA 92630 INSURERA: Nonprofits Insurance Alliance of California 10023
<br /> INSURED INSURER B: State Compensation Insurance Fund 35076
<br /> Orange County Children's Therapeutic Arts Center INSURER C
<br /> 2215 N.Broadway INSURER D
<br /> INSURER E:
<br /> Santa Ana CA 92706 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: All 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 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 /> IPOLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDY EFF MMIDDIYYYY LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> OCCUR PREMkSES Ea occurrence $CLAIMS-MADE FX 500,000
<br /> MED EXP(Any one person) $ 20.000
<br /> A Y Y 2024-09201 4212112024 12121/2025 PERSONAL&ADV INJURY $ 1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 3.000,000
<br /> POLICY ❑ PECROT [g LOC PRODUCTS-COMPIOPAGG $ 3,000,000
<br /> J
<br /> OTHER: $0 Deductible $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> Ea accident
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> A OWNED SCHEDULED Y 2024-09201 12/21/2024 12/2112025 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> �./ HIRED �./ NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY /`� AUTOS ONLY Per accident
<br /> $0 Deductible $
<br /> X UMBRELLA LIAR X. OCCUR EACH OCCURRENCE $ 1,000,000
<br /> A EXCESS LIAB CiAIMS•MADE 2024-09201-UMB 12/21/2024 12/21/2025 AGGREGATE $ 1,000,000
<br /> OLD RETENTION$ 10000 $
<br /> WORKERS COMPENSATION X STATUTE ERH $0 Deductible
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETORIPARTNERIEXECUTIVE YIN 1,000,000
<br /> B OFFICERIMEMBER EXCLUDED? N 1 A Y 9255171-24 06/05/2024 06/05/2025 E.L.EACH ACCIDENT $
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE. $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> $1,000,00011,000,000 AggregatelOccurr
<br /> Social Service Professional Liability
<br /> A Improper Sexual Conduct Liability 2024-09201 12/21/2024 12/2112025 $3,000,000/1,000,000 AggregatelOccurr
<br /> $0 Deductible
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> The City of Santa Ana,its officers,officials,employees,and volunteers are included as Additional Insured per attached endorsement CG2026&NIAC E131&
<br /> NIAC Al. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured,such insurance as is afforded by
<br /> this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of The City of Santa Ana,its officers,
<br /> officials,employees,and volunteers per attached endorsement NIAC E61. 30 day notice of cancellation with 10 day notice of cancellation for non-payment
<br /> of premium per policy provision. See attached forms list. Waiver of Subrogation applies per attached endorsement NIAC F26&10217.
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Cynthia Mora at 10:31 am, Dec 23, 2024
<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 /> Attn:Audrey Goodson
<br /> AUTHORIZED REPRESENTATIVE
<br /> 801 W.Civic Center Dr Ste 200
<br /> Santa Ana CA 92701 .u• �
<br /> 1
<br /> O 1988-2015 ACORD CORPORATION. All rights reserved,
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|