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710/1/2025
<br /> E(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE
<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
<br /> NAME: Melissa Lauer
<br /> ALKEME Insurance PHONE g49 620-6862 FAX No
<br /> TDW Risk Management Associates, LLC vC No Ext: ( )
<br /> 111 Corporate Drive, Suite 200 ADDARESS: mlauer@alkemeins.com
<br /> Ladera Ranch CA 92694 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> License#:OM55604 INSURERA: LIO Insurance Company
<br /> INSURED MOMSORA-01 INSURERB:The Pie Insurance Company 21857
<br /> MOMS Orange County
<br /> 1128 Santa Ana Blvd INSURERC:
<br /> Santa Ana CA 92703 INSURERD:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1664049269 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER MM/DD MM/DD
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y LI01100029914-00 2/24/2025 2/24/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE � OCCUR PREMISES DAMAGE TO
<br /> PREMISES Ea occurrence)
<br /> ccurrence $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 PRO-
<br /> JECT LOC PRODUCTS-COMP/OP AGG $1,000,000
<br /> X
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY LI01100029914-00 2/24/2025 2/24/2026 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED FIR ER DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> L $
<br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION WCPI3047470 10/1/2025 10/1/2026 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE FN] N/A E.L.EACH ACCIDENT $1,000,000
<br /> OFFICE R/M EMBER 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 /> A Professional Liability LI01100029914-00 2/24/2025 2/24/2026 Aggregate 3,000,000
<br /> Sexual/Physical Abuse Liability Each Occurrence 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> Cyber Liability-#C-4LR1-094881-CYBER-2024-Coalition Insurance Solutions-11/01/2024 to 11/01/2025-$1,000,000 Limit-11/01/2017 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 at 8:30 am,Oct 02,2025 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 Digitally signed ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Community Development Agency TU Tran byTuTran
<br /> 20 Civic Center Plaza Nguyen AUI=EIZEDREPRESENTATIVE
<br /> Santa Ana CA 92702 Ng Uyen Date:2025.10.02
<br /> 08:30:58-07'00'
<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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