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Digital ly signed by Francine R. Francine R. Villareal Villareal Date: 2020. 12.1017:26: 25-08'00' CWE0000-01 SGONZALEZ ACC7Ra CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 1213/2/3/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # 0757776 CONTACT Irene Laine NAME: PHONE FAX -7216 (A/C, No, EXt): (714) 739-3184 No):(714) 459 HUB International Insurance Services Inc. 6 Centerpointe Drive Suite 350 a DDRIESS: Irene.Laine@hubinternational.com La Palma, CA 90623 INSURER S AFFORDING COVERAGE NAIC # INSURER A:Crum & Forster Specialty Insurance Company 44520 INSURED INSURER B: West American Insurance Co 44393 CWE INSURER C: State Compensation Insurance Fund of California 35076 1561 E. Orangethorpe Avenue Suite 240 INSURER D : INSURER E : Fullerton, CA 92831 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE DWI Aj OCCUR X X EPK-133225 12/8/2020 12/8/2021 DAMAGE TO RENTED PREMISES Ea occurrence 100 000 $ MED EXP (Any oneperson) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY ❑ PRO ❑ LOC JECT PRODUCTS-COMP/OPAGG $ 4,000,000 $ OTHER: B AUTOMOBILE LIABILITY CMBINED SINGLE LIMIT EaOaccident 1,000,000 $ X BODILY INJURY Perperson) $ ANY AUTO X BAW57609336 12/8/2020 12/8/2021 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE X 9170147-20 12/1 /2020 12/1 /2021 X PER OTH- STATUTE ER E.L. EACH ACCIDENT 1,000,000 $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A E.L. DISEASE- EA EMPLOYEE $ 1,000,UUU If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ A Professional Liab EPK-133225 12/8/2020 12/8/2021 Each Wrongful Act 2,000,000 A Professional Liab EPK-133225 12/8/2020 12/8/2021 Aggregate 4,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Project Name: RFP 20-102. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; officers, agents, employees, representatives and volunteers are Additional Insured with regard to General Liability when required by written contract per the attached endorsement forms EN0111 02/11 and EN0147 11/11, Primary & Non -Contributory and Waiver of Subrogation included. Per project aggregate applies to General Liability per the attached endorsement form EN0301 09/14. Additional Insured with regard to Auto Liability when required by written contract per the attached endorsement form AC8543 06/18. Waiver of Subrogation with regard to Workers Compensation applies when required by written contract per the attached endorsement form 2572. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana ty THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE 1ZisieManagmentDiviaian REVIEWED & APPROVED BY. ACORD 25 2016/03 ( ) © 1988-2015 ACORD C The ACORD name and logo are registered marks of ACORD Risk Management Analyst