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ACORO CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM
<br />`-�
<br />10/23/202019
<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 PGI(cy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain Policies may require an endorsement A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT NAME: Ginger Pioli
<br />Degginger McIntosh and Associates
<br />3977 Harbour Pointe Blvd SW
<br />E
<br />PHONFarc en: M2el7a.-aanl
<br />(425)740-5200
<br />E-MAIL in er@DMAinsce.com
<br />ADDRESg9 uren
<br />S:
<br />INSUREFUSI AFFORDING COVERAGE
<br />NAIC 0
<br />Mukilte , WA 98275
<br />INSURERA: HiscoX Inc.
<br />L19704
<br />INSURED
<br />INSURER B: American Fire and Casualty Co.
<br />Ergometrics & Applied Personnel Research, Inc.
<br />INSURER C: Evanston Insurance Com an
<br />National Testing Network, Inc.
<br />INSURER D:
<br />2122 164th St. SW, Suite 300
<br />_
<br />INSURER E:
<br />Lynnwood WA 98087
<br />INSURER F:
<br />20 GL EA SG TIME! PRO
<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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADEL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDOIWYY
<br />POLICY EXP
<br />MMIDD
<br />LIMBS
<br />A
<br />GENERAL LIABILITY
<br />IPLI004042.19
<br />0/27/2019
<br />0/27/2020
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAINIS-MADE 5x� OCCUR
<br />X
<br />AMAGE TO RENTED
<br />DPREMISES Ea Ottunence
<br />S 50,000
<br />MED EXP (My one person
<br />S 5,000
<br />PERSONAL 3AOV INJURY
<br />S 1,000,000
<br />X DEDUCTIBLE: $2,500
<br />GENERAL AGGREGATE
<br />S 2,000,000
<br />GENL AGGREGATE LIMIT APPLIES PER
<br />PRODUCTS - COMPIOP AGG
<br />S 2,000,000
<br />X POLICY PECT RO LOC
<br />S
<br />B
<br />LIABILITY
<br />8229925
<br />0/27/2019
<br />10/27/2020
<br />CEOMBI DSINGLE LIMIT
<br />1,000,0001
<br />ANYAUTO
<br />BODILY INJURY (Per Person)
<br />S
<br />NOMOBILE
<br />AUTOS ALL NED SCHEDULE.
<br />LTOS
<br />BODILY INJURY (Per accident)
<br />S
<br />X NON-0WNED
<br />HIREDAUTOS AUTOS
<br />PROPERWDAMAGE
<br />P. ixrdeial
<br />5
<br />S
<br />C
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />M0345119
<br />0/27/2019
<br />0/27/2020
<br />EACH OCCURRENCE
<br />S 2,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />S 2,000,000
<br />DEB 'Y RETENTION 5 10,00C
<br />S
<br />A
<br />X0W1G@VO90WSV=
<br />MMXEMPLOYERS' LIABILITY YIN
<br />ANY IPROPRIETOR/PARTNERIEXECUTIVE
<br />OFFCERIMEMBER EXOLUDM7
<br />NIA
<br />rPL1004042.19
<br />A STOP GAP
<br />0/27/2019
<br />10/27/2020
<br />NIC BTATU- X DTH-
<br />El. EACH ACCIDENT
<br />S 1 000 000
<br />El. DISEASE - EA EMPLOYEE
<br />S 1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT
<br />S 1,000,000
<br />DESCRI PTION OF OPERATIONS be.
<br />A
<br />PROFESSIONAL LIABILITY
<br />L1004042.19
<br />0/27/2019
<br />10/27/2020
<br />EACH OCCURRENCE $2,000,000
<br />DEDUCTIBLE: $5,000
<br />TRO DATE 06-23-1998
<br />AGGREGATE $3,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANach ACORD 101, Addition.[ Remark. Sched.I., if more space is ei,dred)
<br />City of Santa Ana its officers, employees, agents and representatives are included as Additional Insured
<br />per attached form WCLP0002CW(1014) with respect to operations of the Named Insured. Coverage is
<br />Primary/Non-Contributory per same form. Notice of Cancellation, Non -Renewal and Material Change on
<br />General Liability and Professional Liability applies per attached Endorsement WCLE6047CW(05/13). All
<br />Endorsements apply per required Written Contract. RE: NTN Testing Services
<br />ULKI WIL:Al t
<br />&4PPR
<br />LFerria7SAM;THA
<br />NA�G�E�3MENT DIVISOI$OVED
<br />i
<br />HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />HE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />4] a
<br />Risk Management DivisionV 13 2019
<br />AUTHORIZED gEPRE5EN1'ATVE
<br />20 Civic Center Plaza
<br />4th Floor
<br />Santa Ana, CA 92702 M.LAMBEIT
<br />Ken McIntosh/OGDON t"
<br />ACORLi 20 (26Tw6o) V 1StSB-2U10 ACORD CORPORATION. All rights reserved.
<br />INS025 (201005).01 The ACORD name and logo are registered marks of ACORD
<br />
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