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A�® CERTIFICATE OF LIABILITY INSURANCE OATE[MMIDDIYYYY}
<br /> 05120121325
<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 Monica OmeZ-
<br /> NAME:
<br /> The Liberty Company Insurance Brokers (AIC. Ext):
<br /> Lic#OD79653 ADDRESS: mgomez@libertycompany.com
<br /> II I Pacifica,Suite 230 INSURERS)AFFORDING COVERAGE NAIC#
<br /> Irvine CA 92618 INSURERA: Philadelphia Indemnity Ins Co 18058
<br /> INSURED INSURER 6: Employers Preferred Ins.Co. 10346
<br /> Templo Calvario Community Development Corp. INSURER c: United States Liab Ins
<br /> 2501 W.5th Street INSURER D:.
<br /> INSURER E:
<br /> Santa Ana CA 92703 INSURERF:
<br /> COVERAGES CERTIFICATE NUMBER: 2025-2026 REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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 /> NSR ADDLISUBRI POLICY EFF POLICY XP
<br /> LTR TYPE OF INSURANCE INSD VWD POLICY NUMBER (MMIDONYYY) (MMIDDNYYY) LIMITS
<br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
<br /> CLAIMS-MA➢E I XI OCCUR PREMISES(Ea occu€rence) $ 10D,000
<br /> MED EXP(Any one person) $ 5,000
<br /> A Abuse&Molestation Y PHPK2641462-014 01/01/2025 01/01/2026 PERSONAL&ADVIINJURY $ 1,000,000
<br /> GEN'LAGGREGATE LIMITAPPLIES PER_. GENERAL AGGREGATE $ 2,000.000
<br /> J ,--y I I"""- I I Loc 2,000,000
<br /> LJ LJ PRODUCTS-C4MPfOPAGG $
<br /> JGI;I
<br /> OTHER: Abuse&Molestation $ 1,000,DOO
<br /> AUTOMOBILE LIABILITY (Ea accident) S
<br /> ANY AUTO BODILY INJURY(Per person) S
<br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> HIRED NOW-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY
<br /> 5
<br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,00o
<br /> A EXCESS LIAB HCLAIMS-MADE PHUBB95936-014 01/01/2025 01/01/2026 AGGREGATE 5 1,000,000
<br /> DEO I X1 RETENTION$ 10,004 5
<br /> C
<br /> WORISERS COMPENSATION PER TH-
<br /> STATUTE ER
<br /> AND EMPLOYERS'LIABILITY Y I N
<br /> ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT 5 1,000,000
<br /> B OFFICERIMEMBEREXCLUDED? ElNfA EIG515929502 01/01/2025 01/01/2026
<br /> (Mandatary in NH) E_L DISEASE-FA EMPLOYEE s 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E_L-DISEASE-POLICY LIMIT 5
<br /> Professional Liability $1,D00,000 Occ&Agg $2.500 Retention
<br /> C Employment Practices ND01555088L 08/25/2024 08/25/2025 $1,000,000 Occ&Agg $5,000 Retention
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> City of Santa Ana,its City Council,officers,officials,employee,agents,and volunteers are named as additionally insured on this policy pursuant to written
<br /> contract,agreement,or memorandum of understanding.Such insurance as is afforded by this policy shall be primary,and any insurance carried by City
<br /> shall be excess and noncontributory. 30 Day Notice Cancellation will be delivered according to policy provisions
<br /> Tu
<br /> UTOR 0�P m <
<br /> ` � APPROVED
<br /> ua` By Tu Tran Nguyen at 9:32 am,Jun 24,2025
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> CITY OF SANTAANA THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> AttrL Executive Director, Community Development
<br /> 20 UV Civic Center Dr,M-25 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701
<br /> ©1988-2016 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
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