|
OLIVCRE-01 KDOHMAN
<br /> ,�►�co�eQ CERTIFICATE OF LIABILITY INSURANCE DAT 118/2 DIYYYY)
<br /> /8/2426
<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 endorsements).
<br /> PRODUCER License#0757776 CONTACT Stephanie Lanzas
<br /> NAME:
<br /> HUB International Insurance Services Inc. PHONE FAX
<br /> 4695 MacArthur Court (AIC,No,E.t):(961)779-8562 (Arc,No):
<br /> Suite 600 EMAIL Ste hanie.Ianzas huk}[nternational.corn
<br /> Newport Beach,CA 92660 ADDRESS: p �
<br /> INSURERS AFFORDING COVERAGE NAIC 4
<br /> INSURER A:Ironshore Special Company 25445
<br /> INSURED INSURER B:Alliance of Nonprofits for Insurance,Risk Retention Group(ANI) 14023
<br /> Olive Crest INSURER C:
<br /> 2130 East Fourth St,Suite 200 INSURER R
<br /> Santa Ana,CA 92705
<br /> 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 /> INSR TYPE OF INSURANCE ADD1-1 SUBRI POLICY NUMBER POLICY EFF POLICY EXP
<br /> LTR MMIDDIYYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g 3,000,000
<br /> X CLAIMS-MADE I OCCUR X HC7BAD05KW001 10I712025 10I712026 PREMISETOEaoccurc0ence s 50,000
<br /> ME❑EXP(Any one erson $ 5,000
<br /> PERSONAL BADVINJURY S 3,000,000
<br /> F13EI'LAGGREGATELIMfTAPPLIESPER: GENERALAGGREGATE $ 4,000,000
<br /> � PRO- 4,000000
<br /> POLICY LOC
<br /> JECT PRODUCTS-COMPIOP AGG S
<br /> OTHER. S
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> IEa accident S
<br /> X ANY AUTO _ X X 02-CP-0002545-01-07 10/8/2025 10/8/2026 BODILY INJURY Perperson) 5
<br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident S
<br /> _
<br /> X ALTOS ONLY X AAUUTOS�ONL� PerracEe,ci.M)AMAGE S
<br /> - S
<br /> B X UMBRELLA LIAB IX OCCUR EACH OCCURRENCE S 1,000,000
<br /> EXCESS LIAB CLAIMS-MADE 02-UB-002545-01-07 10/812025 10/8/2026 AGGREGATE 5 1,400,000
<br /> DE X RETENTION J 4 S
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN STATUTE FR
<br /> ANY PROPRIETORIPARTNERIEXECUTIVE
<br /> OFFICERWEMBER EXCLUDED? N 1 A E.L.EACH ACCIDENT S
<br /> {Mandatory in NH)
<br /> E L.DISEASE-EA EMPLOYEE. 3
<br /> If yes,describe under
<br /> OESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 3
<br /> A Sexual Conduct/Abuse HCIBADDSKWO01 10/712025 10/7/2026 Agg:$4M/Each Claim 3,000,000
<br /> A Professional Liab HC7BADDSKWO01 10/712025 10171'2026 ;Agg:$41M!Each Claim 3,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
<br /> RE: Grant.
<br /> City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers are Additional Insured with regard to General Liability and Auto
<br /> Liability when required by written contract per the attached endorsement form MMF.END.135(3117)and NIA-102BA01125. Waiver of Subrogation applies to
<br /> Auto Liability when required by written contract per form CA04441013. TU Train
<br /> T�T,""N9E'
<br /> NOTE: Nguyen° � '°g
<br /> Sexual Abuse and Misconduct Liability Claims Made!Retention$0.00
<br /> SEE ATTACHED ACORD 101 APPROVER
<br /> By Tu Tran Nguyen a(2:43 ftm,Jars 06,2025
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana Attn; PRCSA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ty ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza
<br /> M-23
<br /> Santa Ana,CA 92701 A(UTHORIZEfDR�EPRESENTATIVE
<br /> ACORD 25(2016103) O 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
|