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�1 HCISYST-01 PATS
<br />fal`oezo CERTIFICATE OF LIABILITY INSURANCE DA 316/2020 (MMsDOlYYvY)
<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(ias) 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 riahts to the certificate holder In lieu of such endorsementlsl.
<br />PRODUCER .- —w o,.,,.,-.,,
<br />Orion Risk Management Insurance Services, An Alera Group Insurance
<br />Agency, LLC
<br />1800 Quail Street Suite 110
<br />Newport Beach, CA 92660
<br />S�gE•r�• •snaroa rvav
<br />�A"�°NN 808.4924
<br />Ess atodd�Torlonrisk
<br />,-,_„___,_, „
<br />INSURED
<br />HCI Systems, Inc.
<br />1354 South Parkside Place
<br />Ontario, CA 91761
<br />COVFRAGFS 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
<br />TYPE OF INSURANCE
<br />AWLbUBR
<br />POLICYNUMBEIR
<br />PODCV EFF
<br />POUCYEXPDI MM/Dnmm
<br />UNITS
<br />A
<br />X
<br />I COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE IX OCCUR
<br />X
<br />51OL014270201
<br />3/212020
<br />3/212021
<br />EACHOCCURRENCE
<br />3 1,000,000
<br />DAMAGETORENTED
<br />100,00EREM1SES(Eaa:cumrI II
<br />MEDEXP h1my Me parecall
<br />A 10,000
<br />PERSONAL & ADV INJ
<br />1,000,000
<br />GEN'L AGGREGATE LpIM�IT� APPLIES PER'.
<br />POLICY ❑X JECT 7 LOC
<br />OTHER:
<br />GENERALAG RE ATE
<br />s 2,000,000
<br />PRODUCTS- COMPIOP AGO
<br />S 21000,000
<br />PROFESSIONAL LI
<br />S 1,000,000
<br />B
<br />AUTONOSILELIABIDTY
<br />X ANY AUTO
<br />OWNED SCHEDULED
<br />AU�ppTEEO��S ONLY AUTOS
<br />WN�p
<br />RUTOS ONLY Al]TOE ONLY
<br />X
<br />54309497
<br />31212020
<br />31212021
<br />COMBINED SINGLE LIMIT
<br />1.000,000
<br />BODILY IN dRY par pamml
<br />s
<br />BODILY INJURY Per said t
<br />P&OPE�R GE
<br />A
<br />X
<br />UMBRELLA LIM
<br />EXCESS LIAR
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />51CCO05185201
<br />31212020
<br />31212821
<br />EACHOCCURRENCE
<br />10,000,000
<br />AGGREGATE
<br />S 10,000,000
<br />DIED I X I RETENTIONS 10,000
<br />B
<br />WORKERS
<br />ND EMPLOYOERS UABIUT' vr�LNN
<br />Mp�Y PROPREIETgO�"ARTNENEXECUTIVE �
<br />IMantlatory In NH) CLUOEO?
<br />CWuFeOr PERATIONS OeIax
<br />MIA
<br />54309496
<br />3l2PL020
<br />3@I2021
<br />OTH
<br />X PSIATM ER ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />s 1,gg8,99D
<br />E.L DISEASE- POLICY LIMIT
<br />'1,000,000
<br />A
<br />Professional Liabill
<br />SIGLO14270201
<br />31212020
<br />31212021
<br />Included in GL Limit
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule ma be attached if mose space is requiredl
<br />City of Santa Ana, officers, employees, agents and Volunteers are included as Additional Insured per the terms of the attached General Liability and Auto
<br />Liability Endorsements.
<br />Primary wording applies per the terms of the attached General Liability and Auto Liability Endorsements.
<br />30 Days' "ties of Cancellation; 10 Days' Notice for Non -Payment (non -reporting If applicable) apply per policy provisions.
<br />CFRTIFICATE HOLDER _ IL, Vrt�-.�J%410N CANCELLATION
<br />gT '�1SkMpt1AG
<br />of Santa Ana (�
<br />City O9
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />6&utk C
<br />Santa Ana, CA 92702
<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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