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ACC CERTIFICATE OF LIABILITY INSURANCE DATE`MM`DD"YYY'
<br /> 09126/2024
<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 Monica Gomez-RM
<br /> NAME:
<br /> The Liberty Company Insurance Brokers PHONE FAX
<br /> AfC No Ext: AIC,No
<br /> Lie AOD79653 E-MAIL mgomez@Ifbertycompany.com
<br /> ADDRESS:
<br /> 47 Discovery,Ste 160 INSURERIS)AFFORDING COVERAGE NAIC N
<br /> Irvine CA 92618 INSURERA: Philadelphia Indemnity Ins Co 1BO58
<br /> INSURED INSURER B: Employers Preferred Ins.Co. 10346
<br /> Templo Calvario Community Development Corp. INSURER C: United States Liability Insurance Company
<br /> 2501 W.5th Street INSURER D
<br /> INSURER E:
<br /> Santa Ana CA 92703 INSURER F
<br /> COVERAGES CERTIFICATE NUMBER: 24-25 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 POLIUES 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 I ADDL SUBIR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMlDDIYYYY MMIDDIYYYY LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO REIN
<br /> CLAIMS-MADE I"I OCCUR PREMISES Ea accurrenre $ 100,000
<br /> MED EXP(Any are person) $ 5,000
<br /> A Y PHPK2641462 01101/2024 01/01/2025 PERSONAL&ADV INJURY $ 1,000,000
<br /> MGEN'LAGGREGATE LIMITAPPLIES PER'. GENERAL AGGREGATE $ 2,000.000
<br /> POLICY ❑ PRU 2,000,000
<br /> JECT LOC -PRODUCTS $
<br /> OTHER: Employee Benefits $ 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br /> Ea accident
<br /> ANYAUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> HIRED NON-OWNED PROPERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000
<br /> A EXCESS LIAB CLAIMS-MADE PHUB895936 01/01/2024 01/01/2025 AGGREGATE $ 1,000,000
<br /> DIED I X RETENTION$ 10,000 $
<br /> WORKERS COMPENSATION PER OTT,
<br /> YrN
<br /> AND EMPLOYERS'LIABILITY STATUTE I ER
<br /> B ANY PROPRIETORIPARTNERIEXECUTIVE E,L.EACH ACCIDENT $ 1,OD0,000
<br /> OFFICERIMEMBEREXCLUDED? ❑ NIA EIG515929501 01/01/2024 01/01/2025
<br /> (Mandatory In NH) El.DISEASE-EA EMPLOYEE_ $ 1,000,000
<br /> flyer,describe under DESCRIPTION OF OPERATIONS befov✓ E L.DISEASE-POLICY LIMIT $ 1.000,000
<br /> C Professional Liability ND01555088L 08/2512024 08/25/2025 $1,000,000 Occ&A
<br /> Employment Practices 99 $2.500 Retention
<br /> $1,000,000 Occ&Agg $5,000 Retention
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it 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.Such insurance as is afforded by this policy shall be primary,and any insurance carried by City shall be excess and
<br /> noncontributory. 30 Day Notice Cancellation will be delivered according to policy provisions
<br /> JAPPROVEfl
<br /> CERTIFICATE HOLDER CANCEL By Cynthia Mara of 12:39 pm, Oct 30, 2024
<br /> CERTIFICATE HOLDER �C A:NC:E
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> CITY OF SANTAANA ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Risk Management Division
<br /> 20 W Civic Center Dr AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92702
<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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