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CITYNET-02 ASUGAHARA
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE(M 5122r202/202YYY)
<br /> 5
<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 License#0757776 CONTACT Amy Sugahara
<br /> NAME:
<br /> HUB International Insurance Services Inc. PHONE FAX
<br /> 1525 Faraday Avenue (A/C,No,Ext):(442)244-6917 (Arc,No);
<br /> Suite 150 E-MAIL am su ahara hubinternational.com
<br /> Carlsbad,CA 92008 ADDRESS: y g @ _
<br /> INSURER 5 AFFORDING COVERAGE NAIL N
<br /> INSURER A:Philadelphia Indemnity Insurance Company 18058
<br /> INSURED INSURER B:Berkshire Hathaway Homestate Insurance Company 20044
<br /> Kingdom Causes,Inc.dba City Net INSURER C:Coalition Insurance Company 29530
<br /> 4508 Atlantic Ave
<br /> Suite 292 INSURER D
<br /> Long Beach,CA 90807--1520 INSURER E.'
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 /> IN5R ADDLi SUBR (POLICY EFF 1 rPIOLII POLICY EXP LIMITS
<br /> LTR TYPE OF INSURANCE IN SD WVD POLICY NUMBER l
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> CLAIMS-MADE J OCCUR X X PHPK2663022-015 3/1612025 3/1/2026 DAMAGE ISOERENT
<br /> ar ence $ 100,000
<br /> I MED EXP(Any oneperson) $ 5,000
<br /> ' PERSONAL&ADV INJURY $
<br /> 2,006,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY F7 JERO 1:1 LOC PRODUCTS-COMPIOPAGG $ 4,000,000
<br /> OTHER:
<br /> A AUTOMOBILE LIABILITY COMBINED ident SINGLE LIMIT 1,000,000
<br /> (Ea acc $
<br /> ANY AUTO X PHPK2708361-000 3/1612025 3/112026 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED X AUTOS ONLY XAUTOS
<br /> BODILY INJURY Per accident $
<br /> AU OSpOLY pacdenTOS ONLY NON-
<br /> ( errc t AMAGE $
<br /> $
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> EXCESS LIAB CLAIMS-MADE PHUB903241-005 311612025 3/112026 AGGREGATE $ 5,000,000
<br /> DED X RETENTION$ 10,0601 $
<br /> B WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> KIWC625771 3/112025 311/2026 E,�._EACHAccIOENT
<br /> AO0NY PROPRIEB RlEXCLUI RIEXECUTIVE N X 1,000,000
<br /> {Mandatory In NH)EXCLUDE07 N1A; 1,000,000
<br /> E.L.EACH
<br /> -EA EMPLOYE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.LUISEASE-POLICY LIMIT $
<br /> C 'CyberlPrivacylNetwor C-4LPY-047969-CYBER-2025 31112025 31112026 Each Claim 2,000,006
<br /> A Misconduct 1 Abuse PHPK2663022-015 311612025 3I11,2026 Aggregate 1,000,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Santa Ana,its City Council,its officers,officials,employees,agents,and volunteers are included as an Additional Insured with respects to the above
<br /> captioned general liability policy where required by written contract.A Waiver of Subrogation also applies to the above Captioned general liability policy
<br /> where
<br /> required by written contract. TU Tra n TuTra°NM, by
<br /> Tu Taan Nguy
<br /> Date:2025 b5
<br /> Professional Liability I Occurrence Form $1,000,000 Each Occurrence 1$2,000,000 Aggregate I No Deductible Policy#PHPK2708361-000 Nguyen m2435-mo.7
<br /> SEE ATTACHED ACORD 101
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 7:24 am,May 27,2025
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn:Homeless Services Division
<br /> 20 Civic Center Plaza
<br /> Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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