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Digitally signed by Francine R.
<br />Francine R. Villareal Villareal
<br />Date: 2021.02.02 15:19:40-08'00'
<br />� CERTIFICATE OF LIABILITY INSURANCE 2i1i2022
<br />DATE (MM/DD/YYYY)
<br />1i26i2021
<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 Lockton Insurance Brokers, LLC
<br />777 S. Figueroa Street, 52nd Ft.
<br />CA License #OF 15767
<br />Los Angeles CA 90017
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />A/C No
<br />E-MAIL
<br />ADDRESS:
<br />(213) 689-0065
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Crum & Forster Specialty Insurance Co
<br />44520
<br />INSURED Rincon Consultants, Inc.
<br />1462718 180 N. Ashwood Ave.
<br />INSURER B : Hartford Fire Insurance Company
<br />19682
<br />INSURER C : Starstone National Insurance Company
<br />25496
<br />INSURER D :
<br />Ventura CA 93003
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES RINCO01 CERTIFICATE NUMBER: 16059509 REVISION NUMBER: XXXXXXX
<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 />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />EPK-133853
<br />2/1/2021
<br />2/l/2023
<br />EACH OCCURRENCE
<br />$ 3,000,000
<br />CLAIMS -MADE 1XI OCCUR
<br />DA AGE To RENTED
<br />'REM SES Ea occurrence
<br />$ 100,000
<br />X
<br />MED EXP (Anyone person)
<br />$ 10,000
<br />SIR: $50,000
<br />X
<br />P&I
<br />PERSONAL &ADV INJURY
<br />$ 3,000,000
<br />GEN'LAGGREGATE
<br />LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4000000
<br />POLICY n PRO -
<br />POLICY nLOC
<br />PRODUCTS -COMP/OPAGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />y
<br />72UENOL5481
<br />2/1/2021
<br />2/1/2022
<br />CFO, MBINED
<br />accidentSINGLE LIMIT
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$ XXX�i;
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$ XXXy,)=
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$ XXX�i;
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />$ XXXXXXX
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />N
<br />N
<br />EFX-116867
<br />2/1/2021
<br />2/1/2022
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />X
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I X I RETENTION $ 10,000
<br />$ XXXXXXX
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y/ N
<br />ANY PROPRIETORPARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />Y
<br />T10210329
<br />2/1/2021
<br />2/l/2022
<br />PER OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 11000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />if
<br />DESCes RIscribe under
<br />PTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Contractors Pollution Liab
<br />N
<br />N
<br />EPK-133853
<br />2/1/2021
<br />2/l/2023
<br />Limit: $3,000,000/$4,000,000
<br />E&O Liab.-Claims Made
<br />Limit: $3,000,000/$4,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 'rI more space is required)
<br />THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S) REFERENCED.
<br />Cyber Liability: Carrier: HDI Specialty Insurance Company, Policy No. Renewal Policy #: SCTRD2590380000, Policy Term: 2/l/2021-2/l/2022, Limit: $5,000,000 SIR: $10,000
<br />The City of Santa Ana and Community Development Agency and their officers, employees, agents and volunteers are an Additional Insured to the extent provided by the policy language
<br />or endorsement issued or approved by the insurance carrier. Waiver of Subrogation applies per attached endorsement(s) or policy language. Insurance provided to Additional Insured(s)
<br />is primary and non-contributory as per the attached endorsement or policy language. Excess policy follows General Liability, Auto Liability and Employers Liability form. Notice of
<br />Cancellation applies per the applicable policy language or endorsements.
<br />16059509
<br />City of Santa Ana
<br />Risk Management Divison
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana CA 92701
<br />ACORD 25 (2016103)
<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 />AUTHORIZED REP
<br />WSW Gt
<br />Risk Manggemerit Division
<br />1°x REVIEWED & APPROVED BY:
<br />a 1688-20lrACGORD C
<br />The ACORD name and logo are registered marks of ACORD _ Wsk Pjanagement Analyst
<br />
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