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Digitally signed by Francine R.
<br />Francine R.
<br />Villareal
<br />/*. I I --.I Date: 2022.01.1210:50:04
<br />1 ® V II1A1 CQI
<br />ACCOR 0 CERTIFICATE OF LIABILITY INSURANCE
<br />r 19Xf (MM/DD/YYYY)
<br />1/3/2022
<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 endorsement(s).
<br />PRODUCER
<br />Lovitt & Touche A Marsh and McLennan Agency, LLC
<br />1050 W Washington Street, Suite 233
<br />Tempe AZ 85281
<br />CONTACT
<br />NAME: Kolby Kearney
<br />PHONE Ext : 602-792-2300 FAX No : 602-956-2258
<br />(AMAIL
<br />ADDRESS: kkearney@lovitt-touche.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />wsURERA: HCC Specialty Insurance Company
<br />11243
<br />INSURED NATIHOU-Cl
<br />Nati's House
<br />INSURER B :
<br />Neutral Ground
<br />INSURERC:
<br />INSURERD:
<br />1733 Valencia St
<br />Santa Ana CA 92706
<br />INSURERE:
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 1943061794 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 />POLICYNUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />H21SS2007101
<br />1/6/2022
<br />1/6/2023
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE � OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 50,000
<br />X
<br />VIED EXP (Any one person)
<br />$ 5,000
<br />1,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />POLICY ❑PRO�
<br />JECT LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 1,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />H21SS2007101
<br />1/6/2022
<br />1/6/2023
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<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 />UMBRELLALIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />PER OTH-
<br />STATUTE ER
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />A
<br />Professional Liability
<br />H21SS2007101
<br />1/6/2022
<br />1/6/2023
<br />Each Claim
<br />1,000,000
<br />Prof Aggregate
<br />3,000,000
<br />Sexual/Physical Abuse
<br />SAML Aggregate
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Certificate holder is named Additional Insured to General Liability coverage if required by written contract, subject to all policy terms, conditions, definitions and
<br />exclusions. Primary/Non-Contributory applies. Notice of Cancellation for Specified Entity, City of Santa Ana.
<br />"City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or
<br />memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City shall be excess and
<br />noncontributory."
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL
<br />BE DELIVERED IN
<br />The City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701
<br />ILLS3R &Y1AgY.1'Yt2t'tt D1V18101t
<br />a
<br />1°x
<br />REVIEWED & APPROVED BY.-
<br />@ 1988-2015 ACORD C
<br />ACORD 25 (2016103)
<br />The ACORD name and logo are registered marks of ACORD
<br />, _,___._—
<br />WskManagement Analyst
<br />
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