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CITYNET-02 ASUGABAR
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE1
<br /> 6l18120vYYY)
<br /> 12025
<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 pollcy(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 tuugahara
<br /> HUB International Insurance Services Inc. PHONE
<br /> 1625 Faraday Avenue (A1C,No,Ext),.(442)244-6917 FAX No):
<br /> Suite 150 ao r& .amy.sugahara@hubinternational.com
<br /> Carlsbad,CA 92008 INSURER(S)AFFORDING COVERAGE NAIL x
<br /> INSURER A:Philadelphia Indemnitv Insurance Company 18058
<br /> INSURED INSURER B:Berkshire Hathaway Homestate Insurance Company 20044
<br /> Kingdom Causes,Inc.dba City Net
<br /> 4508 Atlantic Ave INSURER C
<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 PERI00
<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 SUBJECTTO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_.
<br /> INSR TYPE OF INSURANCE_ Y ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP
<br /> WY D LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 3 2,000,000
<br /> CLAIMS-MADE LX] OCCUR PHPK2663022-015 3/1612025 311/2026 PR MISErORENTED 3 100,000
<br /> -- MED EXP(Any oneperson) S 5,Daa
<br /> PERSONAL&ADV INJURY S 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 4,000,000
<br /> PRO-
<br /> PRODUCTS POLICY JECT LOC PRODUCTS-COMPIOPAGG 3
<br /> OTHER:
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,aaa,000
<br /> 3
<br /> ANY AUTO PHPK2708361-000 3/16/2025 311/2026 BODILY INJURY Perperson) S
<br /> OWNED AUTOS ONLY X A SCHEDULED BODILY INJURY Per accident 3
<br /> X AU X AUSONL�TOS ONLY O POad� DAMAGE
<br /> S
<br /> A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE 3 5,000,000
<br /> EXCESS UAB CLAIMS-MADE PHUS903241-005 3/16/2025 31112026 AGGREGATE y 5,000,000
<br /> DED X RETENTIONS 10,000 S
<br /> B WORKERS COMPENSATION X I PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN N T'FIJTE ER
<br /> ANY PROPRl£TORIPARTNERJEXECUTIVE KlWC625771 3/1/2025 311/2026 1,OOa OOa
<br /> E.L.EACH ACCIDENT $
<br /> OFFICERfMEMBE EXCLUOEO9 N 1 A e
<br /> {MMandatory in NH)
<br /> If yes,describe under E.L.DISEASE-EA EMPLOYEE S 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,oDa
<br /> A Misconduct/Abuse PHPK2663022-015 311612025 31112026 See Below for Limits
<br /> A Professional Liab PHPK2663022-015 3/1612025 31112026 See Below for Limits
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> Umbrella Liability applies to General Liability, Employers Liability,Professional Liability and Abuse and Misconduct Liability Only
<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 required by written contract, TU TCan °9Raoy"r by
<br /> Professional Liability I Occurrence Form 1$1,000,000 Each Occurrence 1$2.000,000 Aggregate I No Deductible T.rm o2sne.itAbuse&Misconduct Liability I Occurrence Form 1$1,000,000 Each Occurrence 1$1,000,000 Aggregate I No Deductible Nguyen 02 06s9-071
<br /> SEE ATTACHED ACORD 101
<br /> CERTIFICATE HOLDER CANCELLATION APPINUM)
<br /> 9y Tu Tram Nguyen of 12:06 pm,Jun 19,2025
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana-Substance Abuse Treatment Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS,
<br /> Attention:Executive Director
<br /> Community Development Agency
<br /> 20 Civic Center Plaza M-30 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana,CA 92701
<br /> J/1.1 _
<br /> ACORD 25(2016/03) t01988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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