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Francine R. o9ft lly e9�ae er F,ancmea
<br />.area
<br />Villareal Dare: 2mo.mmoe:ae35
<br />aroa
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DA TE (MMMD2o )
<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: U the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the forme and conditions of the policy, certain policies may require an endorsement A statement on
<br />this certificate does not confor rights to the certificate holder In lieu of such endoreemen s .
<br />PRODUCER
<br />CONTACT Nora Wolkoff
<br />NAME: _
<br />Dickerson Insurance Services an Alem Group Company
<br />1918 Riverside Drive, Los Angeles, CA 90039
<br />PNONE 323-805-2918 FAX Not,
<br />E-MAIL , Nora@dlckemon-group,com
<br />License#OM29112
<br />INSURE b AFFORDING COVERAGE
<br />NAILS
<br />INSURER A: Philadelphia Indemnity Insurance Company
<br />18058
<br />INSURED
<br />INSURER B: Serves American Indemnity Company
<br />39152
<br />Charitable Ventures of Orange County
<br />INSURER C :
<br />4041 MacArthur Blvd Ste 510
<br />INSURFAO:
<br />Newport Beach, CA 92660-2503
<br />INRER':
<br />IxsSUuRER 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 />INBR
<br />TYPEOFINSURANCE
<br />AOOLB
<br />POLICY NUMBER
<br />MMmparrY
<br />LIMITS
<br />A
<br />COMMERCUIL GENERALLWaILfTY
<br />CWMSMADE ® OCCUR
<br />SewlaitPhysical Abuse
<br />Y
<br />PHPK2137435
<br />E07/15/2020,;67145=1
<br />RENCE
<br />S 1.000,000
<br />s 100,000
<br />ono non
<br />s 5.000
<br />ADV INJURY
<br />MSING�
<br />$ 1.000,000
<br />GENT- AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑ JECT LOC
<br />OTHER:
<br />GREGATE
<br />$ 2,000,000
<br />COMPpPAGG
<br />$ 2,000,000
<br />GREGATE
<br />s 300,000
<br />A
<br />AUTOMOBILELUIBILITY
<br />ANY AUTO
<br />OIMED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON-OMED
<br />AUTOSONLY AUTOSONLY
<br />Y
<br />PHPK2137435
<br />07115/2020
<br />07/15/2021
<br />(EaaWdonIINGLE LIMIT
<br />S 1,000,000
<br />BODILY INJURY (per person)
<br />S
<br />BODILY INJURY (Per amdam)
<br />b
<br />PROPERtt DAMAGE
<br />Peramde rm
<br />S
<br />S
<br />A
<br />UMBRELLA LAB
<br />EXCESS DAB
<br />OCCUR
<br />CWMs-MADE
<br />Y
<br />PHUB723821
<br />0711512020
<br />07/15/2021
<br />EACH OCCURRENCE
<br />S 4,000.000
<br />AGGREGATE
<br />S 4,000,000
<br />DED
<br />1X1 RETENTIONS 10,000
<br />S
<br />B
<br />WORItERS COMPENSATION
<br />ANDEMPLOYERS'LUBILnY
<br />ANY PROPRIETORIPARTNERIEXECLInVE YIN
<br />OFFICERIMEMBER EXCLUDED? O
<br />IMandaton,hNH)
<br />rcyyes, deso i e, umler
<br />DEBLRIPTIONOFOPERATIONSMI.
<br />NIA
<br />SATIS0326700
<br />07/16/2020
<br />07/15/2021
<br />STA RTM
<br />E.L EACH ACCIDENT
<br />S 1,000.000
<br />E.L. DISEASE - EA EMPLOYEE
<br />S 1,000,000
<br />E.L DISEASE - POLICY UNIT
<br />S 1.000.000
<br />q
<br />Property / Equipment Coverage
<br />PHPK2137435
<br />07115/2020
<br />07115l2021
<br />Limit of Insurance
<br />. 127,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional RamerbScNefule, may W aeeeMd if more space is required)
<br />CITY-4ts of6cars, employees, agents, volunteers, and representallves are included as Additional Insureds with respect tD the operations Of the named insured
<br />subject to policy terms and Conditions.
<br />City of Santa Ana
<br />Risk Management Division, 4th Floor
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<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 />AUTHORIEDRFPRESENTATNE /
<br />NORA WOLKOFF ' 0
<br />®1988-2015 ACORD CO
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />Risk MAnagamntt Division
<br />REVIEWED Sr APPROV® BY:
<br />�LSLllJi'JL' F'Wn,Gi.tet Z. U�
<br />Rol, Management Analyst
<br />
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