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D {� Digitally signed by Tori Pierson
<br />Tori 1 ierso1 1 Date: 2022.06.0814:47:04
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<br />��.., SCOTFAZ-01 MCCOWANA
<br />CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
<br />5/18/2022
<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 # OE67768
<br />IOA Insurance Services
<br />4370 La Jolla Village Drive
<br />Suite 600
<br />San Diego, CA 92122
<br />C ACT Ali Smith
<br />PAHICC o, Exl : 619) 788-5795 50206 FA/C, No): 619 574-6288
<br />AI
<br />-L . Ali.Smith@ioausa.com
<br />INSURER 3 AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A:RLI Insurance Company
<br />13056
<br />INSURED
<br />Scott Fazekas $ Associates, Inc.
<br />9 Corporate Park Drive
<br />Irvine, CA 92606
<br />INSURER B; Continental Casualty Company
<br />20443
<br />INSURER C :
<br />INSURER D :
<br />INSURER E
<br />INSURER F :
<br />COVFRAGFS CERTIFICATE NUMRFR: REVISION NUMRFR: 1
<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 LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUER
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />X
<br />PSB0003027
<br />615/2022
<br />6/5/2023
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED PREMISES (Ea occurrencel
<br />$ 11000,000
<br />X
<br />MED EXP An one person)
<br />10,000
<br />Cont Liab/Sev of Int
<br />PERSONAL & ADV INJURY
<br />1,000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER:
<br />POLICY [XI JPPCOT LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />PSB0003027
<br />6/5/2022
<br />6/5/2023
<br />BODILY INJURY Per accident
<br />X
<br />PerOacEclRdent AMAGE
<br />$
<br />ED
<br />AUTOS ONLY X Al]TOS ONNLY
<br />ANo Co. Owned
<br />ulosA
<br />X
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />I
<br />AGGREGATE
<br />$ 2,000,000
<br />EXCESS LIAR
<br />I CLAIMS -MADE
<br />PSE0001119
<br />61512022
<br />6/512023
<br />DED I X I RETENTION $ 0
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y I N
<br />ANY PROPRIETOR/PARTNERIEXECUI IVE
<br />pFFICER/MEMg F�CCLUDED?
<br />(Mandatory In N
<br />ttyS describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N I A
<br />PSW 0001945
<br />6/5/2022
<br />6/5/2023
<br />X PER OTH-
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />B
<br />Professional Liab.
<br />MCH288352513
<br />6/5/2022
<br />6/5/2023
<br />Per Claim
<br />2,000,000
<br />B
<br />Ded.: $20k Per Claim
<br />MCH288352513
<br />6/512022
<br />6/512023
<br />Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />Re: All Operations
<br />City of Santa Ana, its officers, employees, volunteers, representatives and agents are Additional Insureds with respect to General Liability per the attached
<br />endorsement as required by written contract.
<br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions..
<br />City of Santa Ana
<br />Attn: Risk Management Divison
<br />20 Civic Center Plaza, 4th Floor
<br />SHOULD ANY OF THE ABOVE DESCRIBES ------
<br />THE EXPIRATION DATE THEREOF, _-- -__-;M -- _-
<br />ACCORDANCE WITH THE POLICY PROVI:
<br />REviEwED & ,APPRcyvED By.,
<br />AUTHORIZED REPRESENTATIVE
<br />R�
<br />•.... .,. .. Ca7.fiwaseyeircnz Clznra9 Aid,
<br />ACORD 25 (2016103) ©1988.2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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