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Digitallysigned by Tori Pierson <br />Tori Pierson Date. 2022.05.11 16:5026 <br />- <br />RICHWAT-01 JVITITOE <br />ACORO"° CERTIFICATE OF LIABILITY INSURANCE <br />`..•--''" <br />DATE(MM/DD/YYYY) <br />9/29/2021 <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 Deborah A. Paladino, CiC, IAIP <br />NAME: <br />PHONE <br />(A/C, No, Ext): (818) 808-1050 (A/c, No):(818) 986-8510 <br />Hoffman Brown Company <br />5000 Van Nuys Blvd. 6th Floor <br />Sherman Oaks, CA 91403 <br />E-MAIL dpaladino@hoffmanbrown.com <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURERA:Vigilant Ins. Company <br />20397 <br />INSURED <br />INSURER B : Federal Insurance Co. <br />20281 <br />INSURER 7 <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 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 />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDD/YYYY <br />POLICY EXP <br />MMIDD/YYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE X OCCUR <br />X <br />X <br />35293250 <br />10/1/2021 <br />10/1/2022 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />1,000,000 <br />$ <br />MED EXP (Any oneperson) <br />$ 10,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />❑ PRO- ❑ <br />POLICY JECT X LOC <br />PRODUCTS-COMP/OPAGG <br />Included <br />$ <br />$ <br />OTHER: <br />B <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />1,000,000 <br />$ <br />BODILY INJURY Perperson) <br />$ <br />ANY AUTO <br />74967929 <br />10/1/2021 <br />10/1/2022 <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY Per accident <br />$ <br />X <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />Y/N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />71726476 <br />10/1/2021 <br />10/1/2022 <br />X PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />1,000,000 <br />$ <br />OFFICER/MEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />N/A <br />E.L. DISEASE- EA EMPLOYEE <br />$ 1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />1,000,000 <br />$ <br />DESCRIPTION OF OPERATIONS / LOCATIONS / 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 />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza, 4th floor <br />Santa Ana, CA 92701 <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 PROM—— <br />AUTHORIZED REPRESENTATIVE WJ_ff> & AllWlt7M1dB 816 <br />Risl<twA�ar�genreri4CYeriralP,iidie <br />ACORD 25 (2016/03) © 1988-2015 ACORD C( <br />The ACORD name and logo are registered marks of ACORD <br />