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<br />,4CORo" CERTIFICATE OF LIABILITY INSURANCE
<br />DAM DIYYYY)
<br />5/5/2
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<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 endorsement(s).
<br />PRODUCER License # 0814758
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (818) 986-8200 (AM,No):(818) 986-8510
<br />Hoffman Brown Company
<br />5000 Van Nuys Blvd.6th Floor
<br />Sherman Oaks, CA 91403
<br />ADDRESS:
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Vigilant Ins. Company
<br />20397
<br />INSURED
<br />INSURER B: Federal Insurance Co.
<br />20281
<br />INSURERC:
<br />Richards, Watson & Gershon
<br />INSURER D:
<br />350 South Grand Ave., 37th Floor
<br />Los Angeles, CA 90071-3101
<br />INSURER E
<br />INSURER F
<br />COVERAGES 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 CONTRACTOR 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 />ADDLSUBR
<br />POLICYNUMBER
<br />POLICY EFF
<br />POLICY UP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />35293250
<br />10/1/2019
<br />10/1/2020
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />1,000,000
<br />$
<br />MED EXP (Anyoneperson)
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GENU
<br />AGGREGATE LIMITAPPLIES PER
<br />JECTPRO- ❑
<br />POLICY PRO- X LOC
<br />OTHER'.
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMP/OPAGG
<br />Included
<br />$
<br />$
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />AUTOS ONLY X AUTOS ONE
<br />74967929
<br />10/1/2019
<br />10/1/2020
<br />(COM BI NED S INGLE LIMIT
<br />Ea be dent)
<br />1,000,000
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />(Per accRtlent WAGE
<br />$
<br />B
<br />X
<br />UMBRELLA LAB
<br />EXCESS LAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />79611586
<br />10/1/2019
<br />10/1/2020
<br />EACH OCCURRENCE
<br />$ 9,000,000
<br />AGGREGATE
<br />$ 9'000'000
<br />DED RETENTION$
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETowPARTNEwExecLrrlvE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />f yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />71726476
<br />10/1/2019
<br />10/1/2020
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACHACCIDENT
<br />$ 1,000,000
<br />E. L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E. L, DISEASE -POLICY LIMIT
<br />1,000,000
<br />$
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ana, its employees, officers and agents are named as an Additional Insured as required by written contract per Endorsement Form #80-02-2367
<br />attached. Coverage subject to policy terms, conditions and exclusions.
<br />30 day notice of cancellation applies to the certificate holder in event of cancellation except for non-payment of premium is 10 days.
<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 />City of Santa Ana AUTHORIZED REPRESENTATIVE
<br />Risk Management Division / /� Rime D& APPROVED By.,
<br />20 Civic Center Plaza, 4th floor (,�r":[L,... jjj ��\\REVIEWED&APPROVm BY:
<br />Santa Ana CA 92701 °_111ii:11.14'.L' �aas.o:a•e �. V:,�Qsnab.�
<br />ACORD 25 (2016/03) ©1988-2015 ACORD C ��,
<br />The ACORD name and logo are registered marks of ACORD ® Risk Management Analyst
<br />
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