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AI �Rbid CERTIFICATE OF LIABILITY INSURANCE <br />GATE IMM/DD YYYY) <br />09125120/2 <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(les) 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 />CONTACT Customer Service Team <br />NAME: <br />Preferred American Insurance <br />P.O. Box 79498 <br />(P N o 1; (888) 745-0002 nIc No o (888) 834-0006 <br />E-MAILss: customemewice®preferredameriC n.com <br />ADDR <br />INSURERIS) AFFORDING COVERAGE <br />NAIC D <br />Corona CA 92877 <br />INSURERA: Colony Insurance Company <br />39993 <br />INSURED <br />INSURER B: Travelers Insurance Company <br />19046 <br />TSG Enterprises, Inc. <br />INSURER C: National Union Fire Insurance Company of Pittsburgh <br />19445 <br />dba: The Solis Group <br />INSURER D; Sirius America Insurance Company <br />38776 <br />131 N. El Molino Ave., Suite 100 <br />INSURER E: Argonaut Insurance Company <br />19BO1 <br />Pasadena CA 91101 <br />INSURER F: <br />COVERAGE$ CERTIFICATE NUMBER: ULZU614U5b95 REVISION NDMRFR- <br />THIS IS TO CERTIFY THATTHE 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 MAYBE 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 />ADULSUOR <br />INSD <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DDNYYY <br />POLICY UP <br />MMIDDA'YYY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />EACH OCCURRENCE <br />1,000,000 <br />$ <br />PREMISES Ea occurrence <br />$ 100.000 <br />MED UP(Any one parson) <br />$ 5,000 <br />PERSONAL&ADV INJURY <br />$ 1,000,000 <br />A <br />Y <br />Y <br />103 GL 0005702-10 <br />08/20/2020 <br />08/20/2021 <br />GEN'LAGGREGATE LIMITAPPLIES PER: <br />POLICY JRI <br />ECT LOC <br />GENERALAGOREGATE <br />$ 2,000,000 <br />PRODUCTS - COMPIOPAGG <br />$ 2,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SING LE LIMIT <br />Ea accident <br />§ 1,000,000 <br />X <br />BODILY I NJU RY(Par person) <br />$ <br />ANYAUTO <br />B <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />Y <br />Y <br />BA-8N813360-20-42-G <br />08/20/2020 <br />08/20/2021 <br />BODILY INJURY (Per accldenp <br />$ <br />X <br />HIRED NON -OWNED <br />AUTOS ONLY X AUTOS ONLY <br />PROPERTY DAMAGE <br />PeraccideM <br />$ <br />X <br />UMBRELLA LIAR <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 4,000,000 <br />C <br />EXCESSLlae <br />CLAIM&MADE <br />EBU 068430212 <br />08120/2020 <br />08/20/2021 <br />AGGREGATE <br />$ 4,000,000 <br />DED <br />I RETENTION $ <br />$ <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory in NH) <br />DESCRI TION under <br />DESCRIPTION OF OPERATIONS belmv <br />NIA <br />Y <br />WC 25205 <br />01/01/2020 <br />01/01/2021 <br />PER OTH- <br />X STATUTE ER <br />E.L. EACH ACCIDENT <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 />E <br />Professional Liability (E&O) <br />121 MPL 0001549-02 <br />08/20/2020 <br />08l20f2021 <br />Limit: <br />[$2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addlllonal Remarks Schedule, may be attached If more space is required) <br />RFP 20-096 CAA Professional Administrative Services <br />City of Santa Ana, Its officers, employees, agents and representatives are Additional Insureds with respect to General Liability and Auto Liability per the <br />attached endorsements or as required by written contract. Insurance is Primary and Non -Contributory. 30 Days' Notice of Cancellation with 10 Days' Notice <br />for Non -Payment of premium in accordance with the policy provisions. <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana <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 REPRESENTATIVE <br />CA 92702 I \ rJ,r. Ad <br />All rinhf roannmd <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />