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rranane K. Francine R Villareal <br />Date: 1120.09.02 <br />Villareal <br />10:18:53-07'00' <br />'4� �® CERTIFICATE OF LIABILITY INSURANCE <br />OMMIDDN <br />DATE(MMro020 <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 endomement(s). <br />PRODUCER <br />ADD Risk Services Northeast, Inc. <br />New York NY Office <br />One Liberty Plaza <br />165 Broadway, suite 3201 <br />CONTACT <br />NAME: <br />PHONE (g66) 283-7122 FAX <br />(NC. No. Eat): pro_No,; (800) 363-0105 <br />E-MAIL <br />ADDRESS: <br />New York NY 10006 USA <br />INSURER(S) AFFORDING COVERAGE <br />NAIL# <br />INSURED <br />LOS Angeles SMSA LP <br />dba Verizon wireless <br />INSURERA: National Uni On Fire Ins CO of Pittsburgh <br />19445 <br />INSURER B: AIL 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 15 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 />INSR TYPE OF INSURANCE POLICY NUMBER LTR INSD MD MMn1GrYyYy MMID-I LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />Y <br />Y <br />GL <br />EACH OCCURRENCE <br />$2,000,005 <br />CLAIMS -MADE X❑ OCCUR <br />D A ETO N ED <br />PREMISES Ea ccwpre nce <br />$2,000,000 <br />X <br />MED EXP (Any one Person) <br />$10, 000 <br />XCU Coverage Is Included <br />PERSONAL a ADV INJURY <br />$2,000,000 <br />GEN-LAGGREGATE LIMITAPPLIES PER: <br />PRO- <br />X POLICY JECT LOG <br />GENERALAGGREGATE <br />$S,000,000 <br />PRODUCTS-COMPIOPAGG <br />$5,000,000 <br />OTHER: <br />A <br />AUTOMOBILE LIABILITY <br />CA 4594298 <br />ADS <br />06/30/2020 <br />06/30/2021 <br />COMBINED SINGLE LIMIT <br />a accidentl <br />$1,000,000 <br />BODILY INJURY( Per person) <br />A <br />X ANYAUTO <br />CA 4594299 <br />06/30/2020 <br />06/30/2021 <br />A <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIREDAUTOS NON -OWNED <br />ONLY AUTOSONLY <br />MA <br />CA 4594300 <br />VA <br />06/30/2020 <br />06/30/2021 <br />BODILYINJURY(PBr acPdI <br />PROPERTY DAMAGE <br />Peracddenl <br />A <br />See Next Page <br />06/30/2020 <br />06/30/2021 <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE <br />EXCESS LIAR <br />H <br />CLAIMS -MADE <br />AGGREGATE <br />DEG <br />RETENTION <br />B <br />C <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR I PARTNER I EXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />IMandI in NH) <br />If yes, descnbe under <br />NIA <br />WC045886576 <br />ADS <br />WCO4SHg6575 <br />CA <br />06/30/2020 <br />06/30/202006/30/2021 <br />06 30/2021 <br />X <br />PER STATUTE <br />OTH- <br />R <br />EL EACH ACCIDENT <br />$1,000,000 <br />E.L. DISEASE -EA EMPLOYEE <br />$1,000,000 <br />E.L. DISEASEPOLICYLIMIT <br />$1,000,000 <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if 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 />m <br />m <br />m <br />do <br />0 <br />ur <br />r <br />0 <br />2 <br />N <br />u <br />E <br />ar <br />U <br />CERTIFICATE HOLDER CANCELLATION -� <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE J <br />POLICY PROVISIONS. <br />city of Santa Ana AUTHORIZED REPRESENTATIVE - <br />Risk Management Division <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana CA 92701 USA 'VIM (O`� <br />J"imadiJr wrLM.R.dDNaDr <br />01988-2015 ACORD CO WVMED s APPROVED a' <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ��. F' W. -a.e Q, W&WAI <br />Risk Management Analyst <br />