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rrancme K. Francine R. Villareal <br />Date. 2020.09.02 <br />Villareal <br />10:18:53 -07'00' <br />II <br />"I d CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMDDG Y) <br />DMSt12DN <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. 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 NV Office <br />One Liberty Plaza <br />165 Broadway, Suite 3201 <br />CONTACT <br />NAME: <br />PHONE <br />(AIM.IExOC866) 283-7122 : FAX No I: (800) 363-0105 <br />EMAIL L <br />ADDRESS: <br />New <br />New York NY 10006 USA <br />INSURER(S) AFFORDING COVERAGE <br />NAIC N <br />INSURED <br />c1baLoa Angeles SMSA LP <br />VAvenue wireless <br />INSURERA: NatlOnal Dni On Fire IDS CO of Pittsburgh <br />19445 <br />INSURER B: AID Insurance Company <br />19399 <br />109 <br />1095 Avenue of the Americas <br />New York NY 10036 USA <br />INSURER c: American Home Assurance Co. <br />19380 <br />INSURER D: New Hampshire Insurance Company <br />23841 <br />INSURER E: <br />nnrrcm arm .. �..�,�,...��............ �................. <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 />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADD[ <br />INSD <br />SWUM <br />POLICYNUMBER <br />POLICY <br />MMIDDfIYYY <br />MMNOIYEAP <br />YYY <br />LIMITS <br />A <br />MMERCIAL GENERAL LIABILITY <br />CLAIMSMADE ❑X OCCUR <br />TX_XC <br />Y <br />Y <br />GL <br />EACH OCCURRENCE <br />$2,000,000 <br />D OR <br />PREMISES Eaaecurance <br />$2,000, 000 <br />MED EXP (Any one person) <br />$10, 000 <br />U Coysmge is Included <br />PERSONAL& ADV INJURY <br />$2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER P <br />RO- <br />% POLICY JECT LOG <br />GENERALAGGREGATE <br />$5, 000, 000 <br />PRODUCTS-COMPIOPAGG$5,000,000 <br />OTHER: <br />A <br />AUTOMOBILE LIABILITY <br />CA 4594298 <br />ADS <br />06/30/202006/3012021 <br />COMBINED SINGLE LIMIT <br />ge, accident <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 AUTOS ONLY <br />P <br />MA <br />CA 4594300 <br />VA <br />06/30/2020 <br />06/30/2021 <br />BODILY INJURY (per accident) <br />PROPERTY DAMAGE <br />Per accident <br />A <br />See Next Page <br />06/30/2020 <br />06/30/2021 <br />UMBRELLALIAB <br />H <br />OCCUR <br />EACH OCCURRENCE <br />EXCESS UAB <br />CLAIMS -MADE <br />AGGREGATE <br />DED <br />RETENTION <br />B <br />C <br />WORKERS COMPENSATION AND <br />EMPLOYERB' LIABILITY YIN <br />ANY PROPRIETOR I PARTNER I EXECUTIVE N <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory in NH) ❑ <br />If ySCRIPTION antler <br />DESCRIPTION un OPERATIONS below <br />NIA <br />WC045886576 <br />ADS <br />WC045886575 <br />CA <br />06/30/2020 <br />06/30/2020 <br />06/30/2021 <br />06/30/2021 <br />)( <br />PER STATUTE <br />OTH- <br />ER <br />EL. <br />E. 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 />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached n 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 />ULK I II-HUAI l- HULUtM CANCELLATION <br />de <br />m <br />oo <br />m <br />0 <br />r <br />N <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 �Katcerd a/i <br />Santa Ana CA 92701 USA <br />1@dLMltlrge mend DN!sian <br />©1988-2015 ACORD CO - REVEw_ & AI"ROVED BY. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD eI'.a ._ R, <br />® Rek Management Analyst <br />