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DATE(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE
<br /> 09/11/2025
<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 CONTACT Monica Gomez-RM
<br /> NAME:
<br /> The Liberty Company Insurance Brokers PHONE FAX
<br /> A/C No Ext: A/C,No):
<br /> Lic#OD79653 E-MAIL an m omez libert com .com
<br /> ADDRESS: g @ y p y
<br /> 111 Pacifica,Suite 230 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Irvine CA 92618 INSURERA: Philadelphia Indemnity Ins Co 18058
<br /> INSURED INSURER B: 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 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 2025-2026 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 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 POLICY EFF POLICY EXP
<br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNcurDrence $ 100'000
<br /> MED EXP(Any one person) $ 5,000
<br /> A X Abuse&Molestation Y PHPK2641462-014 01/01/2025 01/01/2026 PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> JECT
<br /> OTHER: Abuse&Molestation $ 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
<br /> Ea accident
<br /> ANYAUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accide nt) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000
<br /> A EXCESS LAB HCLAIMS-MADE PHUB895936-014 01/01/2025 01/01/2026 AGGREGATE $ 1,000,000
<br /> DED I X1 RETENTION $ 10,000 $
<br /> WORKERS COMPENSATION X1
<br /> SPER TATUTE EORH
<br /> AND EMPLOYERS'LIABI LI TY YIN 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> B OFFICER/MEMBER EXCLUDED? N/A EIG515929502 01/01/2025 01/01/2026
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> Professional Liability/ $1,000,000Occ&Agg $2,500 Retention
<br /> C Employment Practices ND01555088M 08/25/2025 08/25/2026 $1,000,000 Occ&Agg $5,000 Retention
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be 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 /> Digitally signed
<br /> Tu Tra n by Tu Tran
<br /> Nguyen
<br /> Nguyen 15 0fi 52Z07'00' APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 3:06 pm,Sep 11,2025
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> CITY OF SANTAANAAttn:Executive Director, ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Community Development Agency
<br /> AUTHORIZED REPRESENTATIVE
<br /> 20 W Civic Center Dr,M-25
<br /> Santa Ana CA 92701
<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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