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rranane K. Francine R. Villareal <br />Date: 1120.09.02 <br />Villareal <br />10:18:53-07'00' <br />"�® CERTIFICATE OF LIABILITY INSURANCE <br />% <br />DATOB1MID21^YY) <br />M1120 0 <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. If <br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />non Risk Services Northeast, Inc. <br />New York NY Office <br />CONTACT <br />NAME:PHONE <br />(g66) 283-7122 FAX <br />(AIGNo.Eat): AIC N.: (800) 363-0105 <br />One Liberty Plaza <br />165 Broadway, Suite 3201 <br />E-MAIL <br />ADDRESS: <br />New York NY 10006 USA <br />INSURER(S) AFFORDING COVERAGE <br />NAICe <br />INSURED <br />INSURERA: National union Fire Ins CO of Pittsburgh <br />19445 <br />Los Angeles SMSA LP <br />dba Verizon wireless <br />IN B: AIU insurance Company <br />19399 <br />INSURER C: American Home Assurance Co. <br />19380 <br />1095 Avenue of the Americas <br />New York NY 10036 USA <br />INSURER D: New Hampshire Insurance Company <br />23841 <br />INSURER E: <br />INSURER F: <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. Limits shown are as requested <br />LTR <br />TYPE OF INSURANCE <br />INSO <br />WVO <br />POLICY NUMBER <br />PULIUMMIDDYE FF <br />MWDDM YY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />Y <br />Y <br />GL <br />EACH OCCURRENCE <br />$2,000,000 <br />CIAIMS-MADE X❑ OCCUR <br />A ETO RENTED <br />PREMISES Ea orxurmnce <br />$2,000,000 <br />X <br />APED EXP (Any one person) <br />$10, 000 <br />XCU Coverage is Included <br />PERSONAL B ADV INJURY <br />$2,000,000 <br />GEN'LAGGREGATE LIMITAPPLIES PER: <br />GENERALAGGREGATE <br />$5,000,000 <br />X POLICY PR0. JECT LOC <br />PRODUCTS -COMPIOPAGG <br />$5,000,000 <br />OTHER: <br />A <br />LIABILITY <br />CA 4594298 <br />ADS <br />06/30/202006/30/2021 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$1,000,000 <br />BODILY INJURY(Per peman) <br />A <br />NYATOCA <br />4594299 <br />06/30/2020 <br />06/30/2021 <br />AUTOONLYAUTOS <br />FMC)IlLE <br />WNESCHEDULED <br />NLY AUTOS ONLY <br />MA <br />CA 4594300 <br />VA <br />06/30/2020 <br />O6/30/2021IREDAUTOSNON-OWNED <br />BODILY INJURY(Per accideni) <br />ROPERT n DAMAGE <br />A <br />See Next Page <br />06/30/2020 <br />06/30/2021 <br />UMBRELLA <br />OCCUR <br />EACH OCCURRENCE <br />EXCESS LIAB <br />CI -AIMS -MADE <br />AGGREGATE <br />OED <br />RETENTION <br />B <br />C <br />WORKERS COMPENSATION AND <br />EMPLOYERS'LIABILITY YIN <br />MY PROPRIETOR I PARTNER I EXECUTIVE <br />OFFICERRAEMBER EXCLUDED? N <br />NIA <br />WC045886576 <br />ADS <br />WC045886575 <br />06 30 2020 <br />06/30/2020 <br />06/30/2021 <br />06/30/2021 <br />X PER STATUTE OTH- <br />ER <br />E. L. EACH ACCIDENT <br />$1,000,000 <br />E.L. DISEASE -EA EMPLOYEE <br />$1,000,000 <br />(Mandatory In NH) <br />CA <br />It yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -PODGY LIMIT <br />$1, 000, 000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AEdaional Remarks Schedule, may be aM.hed R more space is required) <br />The above -referenced General Liability policy shall cover the tort liability of the Certificate Holder assumed under the <br />underlying agreement between parties for which the certificate has been issued. City of Santa Ana, its council members, <br />officers and employees are included as Additional Insured with respect to the General Liability policy. The General Liability <br />policy shall apply as Primary and Non -Contributory Insurance to each Additional insured listed herein. where permitted by law, <br />the Named Insured parties listed herein waive all rights against City of Santa Ana, its council members, officers and employees <br />listed herein for recovery of damages to the extent these damages are covered by the above -referenced General Liability policy <br />and, as further limited by written contract between the parties. <br />L <br />CERTIFICATE HOLDER CANCELLATION lal <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />POLICY PROVISIONS. <br />City Of Santa Ana AUTHORIZED REPRESENTATIVE <br />Risk Management Division <br />20 Civic Center Plaza, 4th Floor � arJ/6RYu>RD <br />Santa Ana CA 92701 USA <br />©1988-2015 ACORD <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />REVIEWED 6 APPROVED BY: <br />fulwn.i Q, Vj&441.0 <br />RBk Management Analyst <br />