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HomeMy WebLinkAboutInsurance - HHFTC 2526 Liability - County of Fresno.pdf HOPE&HE-01 MGUADIANA ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/16/2025 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 INSURER(S),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 endorsement(s). PRODUCER License#OE02096 CONTACT NAME: DiBuduo&DeFendis Insurance Brokers, LLC PHONNo,Ext):(559)432-0222 (AIAc,No): 6873 N.West Ave,Ste 101 Fresno,CA 93711 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Manufacturers Alliance Insurance Company 36897 INSURED INSURER B:Pennsylvania Manufacturers Association Insurance Company 12262 Hope&Healing Family Therapy Center,Inc. INSURER C:Hartford Casualty Insurance Company 29424 349 E Bullard Ave#102 INSURER D:Lloyds of London 15792 Fresno,CA 93710 INSURER E:State National Insurance Company 12831 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR IN SD WVD MM DD MM DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FIVI X OCCUR 3025011642867 9/9/2025 9/9/2026 DAMAGE TO RENTED 100,000 X X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY El PRO-- LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: HNOA Liability 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED L $ NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident) ccident $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB CLAIMS-MADE 6025011642867 9/9/2025 9/9/2026 AGGREGATE $ 1,000,000 X DED RETENTION$ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER 51 WECBA5UB0 10/16/2024 10/16/2025 1,000,000 ANY PROPRIETOR P /EXECUTIVE ❑ X E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT D Excess SAM Liab SML24518A25 9/9/2025 9/9/2026 See Description E Cyber Liability EHJAD000490944 9/9/2025 9/9/2026 See Description DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) IF ANY FORMS ARE REFERENCED BELOW OR ATTACHED TO AND PART OF THIS CERTIFICATE,THEY WILL APPLY AS REQUIRED PER WRITTEN CONTRACT OR WRITTEN AGREEMENT BETWEEN THE LISTED PARTIES AND THE INSURED AND ARE SUBJECT TO THE POLICY PROVISIONS.IN THE ABSENCE OF SUCH WRITTEN CONTRACT OR WRITTEN AGREEMENT,THE REFERENCED OR ATTACHED FORMS MAY NOT BE APPLICABLE. Re: 349 E Bullard Ave.,#102,Fresno,CA 93710 AND 1322 E Shaw Ave.,Ste 350,Fresno,CA 93710 County of Fresno,its officers,agents,employees,and volunteers,individually and collectively are named as Additional Insured,but only insofar as the operations under this Agreement are concerned as respects General Liability and Abused Conduct Liability per attached company form CG2026 12/19. SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Count of Fresno THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. Department of Behavioral Health Attention Plan Administration 1925 E Dakota Ave AUTHORIZED REPRESENTATIVE Fresno,CA 93726 n 4� ACORD 25(2016/03) /fit ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: HOPE&HE-01 MGUADIANA LOC#: 1 .4 O. ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY License#OE02096 NAMED INSURED DiBuduo&DeFendis Insurance Brokers, LLC Hope&Healing Family Therapy Center,Inc. 349 E Bullard Ave#102 POLICY NUMBER Fresno,CA 93710 EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 ISEE P 1 EFFECTIVE DATE:SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/Locations/Vehicles: Primary and Noncontributory-Other Insurance Condition applies as respects General Liability per attached company form CG2001 12/19. Waiver of Subrogation applies as respects General Liability and Abusive Conduct Liability per attached form CG2404 12/19; as respects Workers'Compensation per attached form WC 04 03 06. Thirty(30) Day Notice of Cancellation apples as respects Liability per form requested from the company-to follow. Ten (10) Day Notice of Non-Payment will bre provided i accordance with policy provisions. ABUSE CONDUCT/Included in Policy#3025011642867/Manufacturers Alliance Insurance Company/9/9/2025-9/9/2026/Abuse Conduct Liability Limits (Sexual Abuse/Molestation)-Claims Made: $1,000,000 Each Abusive Conduct Incident Lmit; $3,000,000 Abusinve Conduct Aggregate Limit. $0 Deductible. Retroactive DAte: 09/09/2025. EXCESS SEXUAL MISCONDUCT AND MOLESTATION LIABILITY/Policy#SML24518A25/Lloyd's of London/9/9/2025-9/9/2026/ Excess Sexual Misconduct and Molestal Liability Limits: $1,000,000 in the aggregate during the policy period for all claims brought by or on behalf of each victim, and $1,000,000 in the aggregate during the policy period for all claims brought by or on behalf of all victims/Retention (Underlying Policies): $1,000,000/$3,000,000 in the aggregate during the policy period for all claims/ Maintenance Retention: $25,000 each victim. PROFESSIONAL LIABILITY/Policy#3825011642867/Pennsylvania Manufacturers Association Insurance Company/ 9/9/2025-9/9/2026/Professional Liability Limits -Occurrence: Maximum Policy Aggregate Limit of Liability: $3,000,000. Supplementary Payments$1,000,000 Occurrence/$3,000,000 Aggregate subject to a Deductible of$2,500. Information Privacy Incidents (HIPAA)Aggregage Sublimits$25,000. CYBER LIABILITY/Policy#EHJAD000490944/State National Insurance Company/9/9/2025-9/9/2026/Cyber Liability Limits: $2,000,000 in the Aggregate/$2,500 Deductible each and every claim/Indemnity Period: 6 months/Waiting Period: 8 hours/ Retroactive Date: Unlimited ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 302501-16-42-86-7 COMMERCIAL GENERAL LIABILITY CIS 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 Organ ization(s): COUNTY OF FRESNO, ITS OFFICERS, AGENTS, EMPLOYEES, AND VOLUNTEERS, INDIVIDUALLY AND COLLECTIVELY DEPARTMENT OF BEHAVIORAL HEALTH -ATTN PLAN ADMINISTRATION 1925 E DAKOTA AVE FRESNO, CA 93726 *APPLIES TO ABUSIVE CONDUCT LIABILITY COVERAGE 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 If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 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; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable limits of insurance. insured only applies to the extent permitted by 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., 2018 Page 1 of 1 INSURED COPY COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 1 INSURED COPY POLICY NUMBER: 302501-16-42-86-7 COMMERCIAL GENERAL LIABILITY CG24041219 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: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): COUNTY OF FRESNO, ITS OFFICERS, AGENTS, EMPLOYEES, AND VOLUNTEERS, INDIVIDUALLY AND COLLECTIVELY DEPARTMENT OF BEHAVIORAL HEALTH -ATTN PLAN ADMINISTRATION 1925 E DAKOTA AVE FRESNO, CA 93726 *APPLIES TO ABUSIVE CONDUCT LIABILITY COVERAGE Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8.Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s)shown in the Schedule above. CG 24 04 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 1 INSURED COPY tuy 414 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 51 WEC BA5UB0 Endorsement Number: 002 Effective Date: 09/09/25 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Hope & Healing Family Therapy Center, Inc. 349 E BULLARD AVE FRESNO CA 93710 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 perform 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 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from gas Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 09/05/25 Policy Expiration Date: 10/16/25