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ACC)R" CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDIYYYY)
<br />02/21/2025
<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 />CONTACT Certificate Issuance Team
<br />NAME:
<br />Comprehensive Insurance Services
<br />HOFAX
<br />PNE (949) 709-5800
<br />AIC Ext : No A)C, No):
<br />26429 Rancho Parkway South
<br />E-MAIL jerem threhensiveinsurance.com
<br />Y ecom p
<br />ADDRESS:
<br />Suite 120
<br />INSURER(S)AFFORDING COVERAGE
<br />NAIC #
<br />Lake Forest CA 9263D
<br />INSURERA: Nonprofits Insurance Alliance of California
<br />10023
<br />INSURED
<br />INSURER B : State Compensation Insurance Fund
<br />35076
<br />America On Track
<br />INSURER C :
<br />600 W. Santa Ana Blvd.
<br />INSURER D :
<br />Ste. 710
<br />INSURER E
<br />Santa Ana CA 92701
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: CL2482907116 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 PER10D
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR 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
<br />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMfDD1YYYY)
<br />POLICY EXP
<br />[MMIDDffYYYJ
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE ❑X OCCUR
<br />°
<br />PREMISES Ea occurrence
<br />500,000
<br />$
<br />MED EXP (Any one perscn(
<br />$ 20,000
<br />PERSONAL & AOV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />Y
<br />2024-06180
<br />09/01/2024
<br />09/01/2025
<br />GEN'L AGGREGATE LIMIT APPLIES PER;
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />POLICY ❑PRO TOO
<br />JECT
<br />PRODUCTS-COMPIOPAGG
<br />$ 3,OOO,D00
<br />$
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />$ 1,000,000
<br />Ea accident
<br />X ANYAUTO
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Y
<br />Y
<br />2024-06180
<br />09/01/2024
<br />09/01/2025
<br />BODILY INJURY (Per accident)
<br />S
<br />HIRED NON -OWNED
<br />PROPERTY DAMAGE
<br />S
<br />AUTOS ONLY AUTOS ONLY
<br />Per accident
<br />S
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />S 4,000,000
<br />AGGREGATE
<br />S 4,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />2024-06180-UMB
<br />09/01/2024
<br />09/01/2025
<br />DIED I I RETENTION 5
<br />S
<br />WORKERS COMPENSATION
<br />X PER OTH-
<br />AND EMPLOYERS' LIABILITY Y1N
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />S 1,000,000
<br />B
<br />ANY PROPRIETOWPARTNERIEXECUTIVE
<br />OFFICER/MEMBEREXCLUE
<br />NlA
<br />Y
<br />9330492-25
<br />01l0112025
<br />01f0112026
<br />E.L. DISEASE- EA EMPLOYEE
<br />S 1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS baIow
<br />E.L. DISEASE - POLICY LIMIT
<br />5 i3OD0,D00
<br />$2,000,00011,000,000
<br />Aggregate/Ea Clm
<br />Improper Sexual Conduct Liability Social
<br />A
<br />Service Professional Liability
<br />2024-06180
<br />09/01/2024
<br />09101/2025
<br />$2,000,00011,000,000
<br />Aggregate/OCCur
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or
<br />memorandum of understanding per attached endorsement CG2026. Such insurance as is afforded by this policy shall be primary, and any insurance carried
<br />by City shall be excess and noncontributory per attached endorsement NIAC E61 & NIAC Al. 30 day notice of Cancellation with 10 day notice of
<br />Cancellation for non-payment of premium per policy provision. Waiver of Subrogation applies per attached endorsements NIAC E26, CA0444 & 10217
<br />Tu Tran Nguyen
<br />Tu Tran DigiraNysignedghy APPROVED
<br />Date: 2025.02.21
<br />NNguyen
<br />u
<br />9 Y 13:57:06-aaao' By Tu Tran Nguyen at 1:56 prn, Feb 21, 2025
<br />City of Santa Ana
<br />Community Development Agency
<br />20 Civic Center Plaza M-25
<br />Santa Ana
<br />CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />O 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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