JCK
ACORD® DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements).
CAME Rachael Orman
Arthur J. Gallagher Risk Management Services, LLC PHONE 0539-1510 500 N Brand Boulevard, Suite 100 (AC. No, Exl): 818-539-9422 COMAL
Glendale CA 91203 ADDRESS: [email protected]
INSURERS) AFFORDING COVERAGE NAIC #
License#: 0D69293 INSURER A: Nonprofits' Insurance Alliance of CA 10023 INSURED WAYMAKE-01
INSURER B: Service American Indemnity Company 39152
Waymakers
440 Exchange, Suite 250 INSURER C:
Irvine, CA 92602 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1353366788 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
EXCLUSION AND COMOTION OF SUCH POLICE THE SHON AN EASE BEN REUSED BE PRECAN HERE SUET TO AL I TENS, INSR
_TR TYPE OF INSURANCE INSD WVD POLICY NUMBER LIMITS
COMMERCIAL GENERAL LIABILITY 2024-12069 10/1/2024 10/1/2025 EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE PREMISES (Ea occurrence) $ 500,000
MED EXP (Any one person) $ 20,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO
X POLICY L LOC PRODUCTS - COMP/OP AGG $3,000,000
OTHER: $
A AUTOMOBILE LIABILITY 2024-12069 10/1/2024 10/1/2025 $1,000,000 X ANY AUTO BODILY INJURY (Per person)
OWNED SCHEDULED BODILY INJURY (Per accident) s
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident 35005500
Comp/Collsion
X UMBRELLA LIAB OCCUR 2024-12069-UMB 10/1/2024 10/1/2025 EACH OCCURRENCE $2.000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000
DED X RETENTIONS A
WORKERS COMPENSATION SATIS0352404 10/1/2024 10/1/2025 STATUTE T TERH
AND EMPLOYERS' LIABILITY
YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? N/ A
(Mandatorv in NH) ELL. DISEASE - EA EMPLOYEE $ 1,000,000 LESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT$1,000,000 Fiduciary 2024-12069-DO 0/1/20 0/1/202 mit/Aggregate/R $1M/S1M/$50,000 Professional Liab. 2024-12069 /1/20 0/1/202 $1,000,000
Deductible: None Aggregate $3,000,000
Nonprofis Insurance Alance of CA - 4,. est F: 01104gdional Remarks Schedul, may be allached t more space requiren APPROVED AS TO FORM olicy: Improper Sexual Conduc
'olicy#: 2024-1206: By:
MICHAEL E. GATES
CITY ATTORNEY
eductible: Nor CITY OF HUNTINGTON BEACH
ee Attached
CERTIFICATE HOLDER CANCELLATION
IOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFO
THE EXPIRATION DATE OTICE WILL BE DELIVERED
City of Huntington Beach
Office of Business Development
2000 Main St. AUTHORIZED REPRESENTATIVE
Huntington Beach, CA 92648
Melussa Guy
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: WAYMAKE-01
LOC#:
ACORD® ADDITIONAL REMARKS SCHEDULE Page 1 of 1
MEEr J. Gallagher Risk Management Services, LLC NAMED INSURED Mine, Ca a Sun 250
POLICY NUMBER
CARRIER I NAIC CODE
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE olici
olicy: CESN0440009323
RE: 7291 Talbert Ave., Huntington Beach, CA 92648.
The City of Huntington Beach, its officers, elected or appointed officials, employees, agents, and volunteers are named additional insured on General Liability and Auto Liability with respect to the operations of the named insured, if required bv written contract or aareement. The insurance provided in the General Liability is primary and any other insurance shall be excess only, and not contributing. Waiver of Subrogation on General Liability, Auto Liability and Workers' Compensation applies in favor of additional insureds. The umbrella and excess coverage does drop down per occurrence and in the aggregate for general liability, sexual misconduct, and professional liability.
ACORD 101(2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: 2024-12069 COMMERCIAL GENERAL LIABILITY
Named Insured: Waymakers CG 20 26 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
City of Huntington Beach, its officers, elected or appointed officials, employees, agents and volunteers.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III - Limits Of Insurance:
with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" If coverage provided to the additional insured is caused, in whole or in part, by your acts or required by a contract or agreement, the most we omissions or the acts or omissions of those acting will pay on behalf of the additional insured is the on your behalf: amount of insurance:
1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of
2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less.
However: This endorsement shall not increase the
1. The insurance afforded to such additional applicable Limits of Insurance shown in the insured only applies to the extent permitted by Declarations. law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured
CG 20 26 12 19 © Insurance Services Office, Inc., 2012 Page 1 of 1
NONPROFITS
INSURANCE
ALLIANCE OF CALIFORNIA
A Head for Insurance. A Heart for Nonprofits. POLICY NUMBER: 2024-12069 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED
PRIMARY AND NON-CONTRIBUTORY
ENDORSEMENT FOR PUBLIC ENTITIES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
A. Section II - WHO IS AN INSURED is amended to include:
4. Any public entity as an additional insured, and the officers, officials, employees, agents and/or volunteers of that public entity, as applicable, who may be named in the Schedule above, when you have agreed in a written contract or written agreement presently in effect or becoming effective during the term of this policy, that such public entity and/or its officers, officials, employees, agents and/or volunteers be added as an additional insured(s) on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by:
a. Your negligent acts or omissions; or
b. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations.
No such public entity or individual is an additional insured for liability arising out of the sole negligence by that public entity or its designated individuals. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization.
B. Section III - LIMITS OF INSURANCE is amended to include:
8. The limits of insurance applicable to the public entity and applicable individuals identified as an additional insured(s) pursuant to Provision A.4. above, are those specified in the written contract between you and that public entity, or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy.
C. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following:
4. Other Insurance
a. Primary Insurance
This insurance is primary if you have agreed in a written contract or written agreement:
(1) That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below; or
NIAC-E61 02 19 Page 1 of 2
NONPROFITS
INSURANCE
ALLIANCE OF CALIFORNIA
A Head for Insurance. A Heart for Nonprofits. POLICY NUMBER: 2024-12069 (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)' own insurance.
Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance
This insurance is excess over:
1. Any of the other insurance, whether primary, excess, contingent or on any other basis:
(a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work";
(b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner;
(c) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I - COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE.
(e) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any "suit" if any other insurer has a duty to defend the additional insured(s) against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of:
(a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and
(b) The total of all deductible and self-insured amounts under all that other insurance. (3) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing
If all of the other insurance available to the additional insureds) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first.
If any other the other insurance available to the additional insured(s) does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers.
NIAC-E61 02 19 Page 2 of 2
POLICY NUMBER: 2024-12069 COMME A 01010
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
/Named Insured: Waymakers
Endorsement Effective Date: 10/1/2024
SCHEDULE
Name(s) Of Person(s) Or Organization(s):
Any person or organization with whom you have a written contract currently in effect or becoming effective during the term of this policy.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations. but on ao ident or the You Undier a conired with
a contract with
CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you per form work under a written contract that requires you to obtain this agreement from us.' You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule.
The additional premium for this endorsement shall be See Below % of the California workers' compensation premium otherwise due on such remuneration.
Schedule
Person or Organization
City of Huntington Beach Office of Business Development Job Description
2000 Main St. Huntington Beach, CA 92648
Specific Waiver is $200 Flat Charge
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Date: 10/01/2024 Policy No. SATIS0352404 Endorsement No.
Policy Effective Date: 10/01/2024 to 10/01/2025 Premium $ Insured: Waymakers
DBA:
Carrier Name / Code: Service American Indemnity Company Countersigned by
WC 04 03 06
(Ed. 4-84)
NONPROFITS POLICY NUMBER: 2024-12069 FORM: NIAC-E26 11 17 NAMED INSURED: Waymakers
INSURANCE
ALLIANCE OF CALIFORNIA
A Head for Insurance. A Heart for Nonprofits.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SOCIAL SERVICE PROFESSIONAL LIABILITY COVERAGE FORM
SCHEDULE
Name of Person or Organization:
Where you are so required in a written contract or agreement currently in effect or becoming effective during the term of this policy, we waive any right of recovery we may have against that person or organization, who may be named in the schedule above, because of payments we make for injury or damage.
NIAC-E26 11 17 Page 1 of 1
NONPROFITS
INSURANCE NONPROFITS INSURANCE ALLIANCE
OF CALIFORNIA (NIAC)
ALLIANCE OF CALIFORNIA
www.insurancefornonprofits.org
A Head for Insurance. A Heart for Nonprofits.
BUSINESS AUTO COVERAGE
ADDITIONAL INSURED/LOSS PAYEE EXTENSION
POLICY NUMBER: 2024-12069-NPO Schedule Al
NAME OF INSURED: Waymakers
ADDITIONAL INSUREDS /
LOSS PAYEE
Additional Insured - NIAC A1
City of Huntington Beach
2000 Main St.
Huntington Beach, CA 92648
As respects vehicles): ALL
Additional Insured - NIAC A1
City of Irvine c/o Ebix RCS
P.O. Box 257
Portland, MI 48875
As respects vehicle(s): ALL
Additional Insured - NIAC A1
City of Irvine c/o EXIGIS Risk Management Services
P.O. Box 947
Murrieta, CA 92564
As respects vehicle(s): ALL
Additional Insured - NIAC A1
City of Irvine, California c/o: Exigis LLC
P.O. Box 4668 ECM #35050
New York, NY 10168
As respects vehicles): ALL
Additional Insured - NIAC A1
City of Irvine, its Officers, Employees, Agents, Volunteers and Representatives, One Civic Center Plaza
P.O. Box 19575
Irvine, CA 92623
As respects vehicle(s): ALL
Additional Insured - NIAC A1
City of Newport Beach, Insurance Compliance
P.O. Box 100085 - FV
Duluth, GA 30096
As respects vehicles): ALL
Panel EQ.
COUNTERSIGNED: 10/1/2024 BY
(AUTHORIZED REPRESENTATIVE)
NIAC - SCHEDULE AI - NPO
NONPROFITS
INSURANCE NONPROFITS INSURANCE ALLIANCE
OF CALIFORNIA (NIAC)
ALLIANCE OF CALIFORNIA
A Head for Insurance. A Heart for Nonprofits. www.insurancefornonprofits.org
BUSINESS AUTO COVERAGE
ADDITIONAL INSURED/LOSS PAYEE EXTENSION
POLICY NUMBER: 2024-12069-NPO Schedule Al
NAME OF INSURED: Waymakers
ADDITIONAL INSUREDS /
LOSS PAYEE
dditional Insured - NIAC A
ounty of Orange HCA Contract Development
Management
405 W. 5th Street, 6th Floor
Santa Ana, CA 92701
As respects vehicle(s): ALL
Additional Insured - NIAC A1
The City of Irvine
1 Civic Center Plaza
Irvine, CA 92606
As respects vehicle(s): ALL
Panel C. Q.
COUNTERSIGNED: 10/1/2024 BY -
(AUTHORIZED REPRESENTATIVE)
NIAC - SCHEDULE AI - NPO