|
Digitally signed
<br />Angie by Angie
<br />7 a Acevedo --IDDffyyy�
<br />AC"R" CERTIFICATE OF LIABILITY INS V R bd W-06- do Date: 202�.08"A1'1(/06I2022
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE jERTIA6%28A)�1AX.0%S
<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 INSUiRER(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 INSILIRED provisions or be endorsed'.
<br />If SUBROGATION IS WAIVED, subject to the terms andl 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 lien of such endorsement(s).
<br />PRODUCER
<br />CON " NAME: Fred Dabid
<br />-
<br />Independent Group Agency
<br />PHONE (818) 380-1391 FAX (818) 290-7497
<br />JIM N% Exth (A/C , No:
<br />EMARIL SS: re fdabiri@igainsunance co
<br />DDE
<br />21700 Oxnard Street
<br />Suite 1045
<br />1 NSUR ER(S) AFFORD NG COVERAGE
<br />NAIC#
<br />Woodland Hills, CA 91367
<br />INSURERA: Sentinel Insurance Company
<br />INSURED
<br />INSURER 8 : California Automobile Insurance Company
<br />VIalron Systems, Inc,
<br />MSURER C: Hartford Fire Insurance Company
<br />INSURER D:
<br />18233 S Hoover Street
<br />INSURER E
<br />Gardena, CA 90248
<br />LINSURER F
<br />COVERAGES CERTIFICATE NUMBER: CL226617341 REVISION NUMBER:
<br />d H9S IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW' HAVE' BEEN ISSUED To rI HE INSURED NAMED ABOVE FCR THE POLICY PERIOD
<br />INDICATE;.) NOTWI 7 HSTANDIING ANY REQUIREMENT TERM OR CCNDFPON OF ANY C01,4TRACT OROr) iER DOCUMENT WITH RESPEG F To WHICH THIS
<br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE, INSURANCE AFFOIRDED BY IHE POLICIES DESCRIBED HEREIN IS SUBJECT TOAT.LTHE TERMS,
<br />EXQLUSIONSANQ CONMITONS OF SUCFrI PCII lCIES LIMITS SHOWN MAY HAVE BEt:::N REDUCED BY PAID CLAIMS
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />'.I SD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />(MWDWYYYY
<br />POLICY EXP
<br />MIMIDDNYYY)
<br />LIMITS
<br />X
<br />COMMERCIAL
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAMS -MADE 19 OCCUR
<br />EACH CCCUHRENCE
<br />$ 1,000,000
<br />DAMAII� 1.1 1-�11 , "�' , , L
<br />REM , . . "C.
<br />, 1,0100,0100
<br />MILD EXF IAny we person)
<br />5 101000
<br />A
<br />Y
<br />57 S BA AV341 7
<br />10120/2021
<br />10/20/2022
<br />PERSONAL &ADV INJURY
<br />$ 1.000,000
<br />I
<br />""',
<br />IG
<br />TAGGREGATE LIMITAPPLIES PER
<br />GENERAL AGGREGATE
<br />$ 2,0100,0100
<br />PQL�C�, 7 PROI�
<br />P", JECT E] LOX;
<br />PRODUCTS - COM P/OP AGG
<br />S 2,W0,000
<br />$
<br />O.ER
<br />AUTOMORLE
<br />LIABILITY
<br />COMIRINED SINGLe LIMIT
<br />(Ea acadent)
<br />s 1,000,000
<br />BODILY INJURY (Pa pemn)
<br />s
<br />><
<br />ANY Au ro
<br />B
<br />OWNED SCHEDULED
<br />AUTCS ONLY AUTOS
<br />Y
<br />BA0400100015173
<br />05J26/2022
<br />05/26J2023
<br />Boob iLy rqJURY (Per acadent)
<br />HIRED NONLOWNED
<br />AUTOS ONLY Alu rOS ONLY
<br />PROPERTY DAMAGE
<br />Per aeY,it1er19
<br />$
<br />X
<br />UMBRELLA NAB
<br />CCCOR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />A
<br />I EXCESS HAS
<br />HCLAIMS-MADE
<br />57 SBAAV3417
<br />10/20d2021
<br />10120/2022
<br />AGGREGATE
<br />S 2,000,000
<br />I-DEL)"i t RETFNITION $
<br />$
<br />WORKERS COMPENSAMON
<br />R T"
<br />AND EMPLOYERS' LIABILITY YIN
<br />LIATUIE ER
<br />E C�l L EAACoDENT
<br />S
<br />ANY PROPRdFr0R/PARTNERIFXECU7IV[
<br />OFFICERMEMBEREXCLUDED? El
<br />WA
<br />I
<br />(Mandatorr In NH)
<br />E _ DISEASE - EA FMPLOY EE
<br />S
<br />dew.ribe under
<br />Idyes
<br />DESCRIPTION OF OPERATICINS below
<br />E L DISEASE - POLICY DMiT
<br />$
<br />ERRORS & CIMMISSIONS LIABILITY
<br />EACH CLAIM
<br />1,000,000
<br />C
<br />(PROFESSIONAL LIABILITY)
<br />72 TE 0294256-22
<br />01/25/2022
<br />011/25/2023
<br />AGGREGATE
<br />5,1300,0100
<br />DESCRIPTION OF OPERATIONS LOCATIONS P VEHICLES JACORD 101, Addinonal Remarks Schedule, may be anachod ifmovie spruce is tequirwu
<br />City of Santa Ana, Its officers, employees, agents anti repre; entafirves have been named as additional insured as respect to the General Liability, per
<br />attached!, town SS00080405. Primary & Non-Corn6butwy applies as wrill, Also named as addilonal insured per attached endorsement # MCA85100817-CA
<br />to the Auto Liabilly.
<br />10 days notice of cancellation for norm -payment, 30 days for any other reason.
<br />City of Santa Ann
<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 E,)ATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE ':��H THE POLICY PROVISIONS.
<br />ALITHORI2 REPRESENTATIVE
<br />CA 92702
<br />@ 1988-2015
<br />ACORD 25,(2016103) The ACORD name and logo are registered marks of ACORD
<br />Rink MuaganentDivislm
<br />ri REVIEWED &APPROVED BY.-
<br />A-* ' Aaw44
<br />Risk Management Specialist
<br />
|