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ACC" CERTIFICATE OF LIABILITY INSURANCE DAT2>`24/2025rr,
<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 pollcy(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 endorsements.
<br /> PRODUCER CONTACT -
<br /> NAME: Melissa Lauer
<br /> ALKEME Insurance PHONE 949 620-6662 P7 No.
<br /> TDW Risk Management Associates, LLC E-MAIL
<br /> 111 Corporate Drive, Suite 200 ADDRESS: miauer@alkemeins.com
<br /> Ladera Ranch CA 92694 INSURERS AFFORDING COVERAGE NAIC#
<br /> License#:OM55604 INSURERA:Oak River Insurance Company 34630
<br /> INSURED MOMSORA-01 INSURER B:LIO Insurance Company
<br /> MOMS Orange County
<br /> 1128 Santa Ana Blvd INSURER C
<br /> Santa Ana CA 92703 INSURER D
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:612414449 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 ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE POLICY NUMBER MMlDDIYWY MM1DD LIMITS
<br /> B X COMMERCIAL GENERAL LIABILITY Y Y L101100029914-00 2/24/2025 2124/2025 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTS❑
<br /> CLAIMS-MADE X OCCUR PREMISES Es occurrence $100,000
<br /> MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3.000,000
<br /> POLICY DPRO-
<br /> JECTLOC PRODUCTS-COMPIOP AGG $1.000,000
<br /> 1RO
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY L101100029914-00 2/2412025 2124/2C26 COMBINED SINGLE LIMIT $1.000,000
<br /> Ea accident
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> Ix
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY X AUTOS ONLY Per accldenE
<br /> UMBRELLA LIAB OCCUR EACHOCCURRENCE $
<br /> EXCESS LIAR HCLAIMS-MADE AGGREGATE $
<br /> DEC RETENTION$ $
<br /> A WORKERS COMPENSATION MOWG547866 101112024 10/1/2025 X I STATUTE ERTH-
<br /> AND EMPLOYERS'LIABILITY Y I N
<br /> ANYPROPRIETORIPARTNERIEXECUTIVE NIA E.L.FACHACGIDENT $1,000,000
<br /> OFFICERIMEMB ER EXCLUDED?
<br /> (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> B Professional Liability L101100029914-OU 2/24/2025 2/24/2026 Aggregate 3,000,000
<br /> SexuallPhysical Abuse Liability Each Occurrence 1,000,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES(ACORD 1flt,Addlt4onal Remarks Schedule,may be attached if more space is required)
<br /> Cyber Liability-#C-4LRI-09488 I-CYBER-2024-Coalition Insurance Solutions-11/0112024 to 11/0112025-$1,000,000 Limit-1 110 1 12 01 7 Continuity Date
<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.Such insurance as is afforded by this policy shall be primary,and any insurance carried by City shall be excess and
<br /> noncontributory.Waiver of Subrogation is included on the Workers Compensation per written contract or agreement with insured.
<br /> *Please note Copyright Laws apply to the Acord form prohibiting us from modifying the cancellation clause.However,per TDW Risk Management Associates,
<br /> LLC procedures we will notify you within 30 days if said policy cancels for any reason other than non-payment.In the event that the policies cancel for
<br /> non-payment,you will be notified within 10 days.
<br /> CERTIFICATE HOLDER APPROVED CANCELLATION
<br /> By Tu Tran Nguyen of 12.21 pm,Mar 25, 2025 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 Digitallysigned ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Community Development Agency Tu Tran by""
<br /> 20 Civic Center Plaza ^' U Nguyen Date: AUT tZED REPRESENTATIVE
<br /> Santa Ana CA 92702 Yen 202
<br /> 1 z:z2:00:oa-m aa•
<br /> Q 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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