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<br />CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNWY)
<br />03/30/2020
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
<br />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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the p011cy(ies) must have ADDITIONAL INSURED provisions or be
<br />endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsements .
<br />PRODUCER 310-542-4600
<br />Higgh Ground Insurance Services
<br />NA Christopher Cordill
<br />E�----..—.-
<br />PHONE 310-542-4600 �FaX -
<br />No, E,q:
<br />2317 Crenshaw Blvd, #304
<br />Torrance, CA 90501
<br />ChristopherCordill
<br />-(Alc, _ _ (alc, N H:310_542-8400
<br />E-MA$ ecor 1 Dni et�(2 nctie—s.com ""--
<br />ApDRR�B g
<br />_
<br />",._ INSURER 5 AFFORDING COVERAGE
<br />NAIC #
<br />_..
<br />INSURERA:THE HARTFORD
<br />..—.... _—_ ....
<br />91000
<br />D
<br />Lan
<br />1234 cape West Mgmt Svcs Inc.34630
<br />1234 North
<br />___
<br />INsuRER B:OAK RIVER INSURANCE COMPANY
<br />--"---
<br />--
<br />--'—
<br />INSURER C." _--
<br />--
<br />Blue Gum Street
<br />Anaheim, CA 92806
<br />INSURER D :
<br />IE:__—...—..—...—._
<br />INSURERNSURER
<br />F:
<br />COVFRACPC
<br />THIS
<br />INDICATED.
<br />CERTIFICATE
<br />EXCLUSIONS
<br />INSR
<br />IS TO CERTIFY THAT THE POLICIES
<br />NOTWITHSTANDING ANY REQUIREMENT,
<br />MAY BE ISSUED OR MAY
<br />AND CONDITIONS OF SUCH
<br />_
<br />TYPE OF INSURANCE
<br />OF
<br />PERTAIN,
<br />POLICIES.
<br />DDL
<br />INSURANCE
<br />UBR
<br />LISTED BELOW HAVE BEEN
<br />TERM OR CONDITION OF ANY
<br />THE INSURANCE AFFORDED BY
<br />LIMITS SHOWN MAY HAVE BEEN
<br />.—..
<br />POLICY NUMBER
<br />ISSUED TO
<br />CONTRACT
<br />THE POLICIES
<br />REDUCED BY
<br />...—.
<br />POLICY ERE
<br />04/0112020
<br />THE INSURED
<br />OR OTHER
<br />DESCRIBED
<br />PAID CLAIMS.
<br />POLICY EXPLIMITS
<br />04/01/2021
<br />NAMED ABOVE FOR THE
<br />DOCUMENT WITH RESPECT
<br />HEREIN IS SUBJECT TO
<br />POLICY PERIOD
<br />TO WHICH THIS
<br />ALL THE TERMS,
<br />A
<br />X
<br />COMMERCIAL GENERAL]OCCITY
<br />CLAIMS -MADE OCCUR
<br />--
<br />jt
<br />72UUNOK7437
<br />EACH OCCURRENCE
<br />S_ 1,000,000
<br />pRAMAG ETOEeE cc ED re
<br />S 300,000
<br />-
<br />$ 6,000
<br />MEDEXP IAnv onapa,sm
<br />""—'—'
<br />'------
<br />GENT AGGREGATE LI MIT APR LI ES PER:
<br />POLICY JECT LOC
<br />PERSONAL B ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />g 2,000,000
<br />PRODUCTS-COMPIOP AGG
<br />S 2,000,000
<br />A
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />X G
<br />OWNED
<br />AWNED SCHEDULED
<br />AUTOS ONLY AUTOS pp
<br />X AUTOS ONLY X AUTOS ONEV
<br />72UUNOK7437
<br />04/01/2020
<br />04/01/2021
<br />Emp Ben,
<br />COMBINED SINGLE LIMIT
<br />Ea ac itlenf
<br />0
<br />g 1,000,oOO
<br />BODILY INJURv Per parsonl
<br />$
<br />BODILY INJURY Per accident
<br />s
<br />PROPERTY AMAGE
<br />(PeraccidenlQ
<br />—
<br />S
<br />EACHOCCURRENCE
<br />$
<br />$ 2,000,000
<br />A
<br />X OCCUR
<br />EXCESS
<br />EXCESSSLIARB CLAIMS -MADE
<br />72HHUOK7438
<br />04/01/2020
<br />04/01/2021
<br />AGGREGATE
<br />S 2,000,000
<br />DED RETENTION$
<br />—
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY
<br />ANY PROPRIETORIPARTNEft/EXECUTIVE �YIN
<br />OFFICER/MEMBE?EXCLUDED? IYJ
<br />Mandatory In NHI
<br />If yes, describe urda,
<br />DESCRIPTION OF OPERANONSbelow
<br />NtA
<br />X
<br />LAWC014309
<br />10l1112099
<br />X PER OTH-
<br />sTAruTE ER
<br />5
<br />10t1112020
<br />EL EACH ACCIDENT
<br />____
<br />$ 1,000,000
<br />E L. DISEASE EA EMPLOYE
<br />5 1,000,000
<br />E. L. DISEASE -POLICY LIMIT
<br />5 1,000,O00
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule, may be attaehed if more space is required)
<br />30 days notice if cancelled. 10 days notice if cancelled for non-payment.
<br />Project: Right of Way and Median Landscape Maintenance Services RFP#19.016 REVIEWED Cox APPROVED
<br />By Risk MANACiFMENT DIVISION
<br />See Holder Notes attached for additional information
<br />u
<br />r 1
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />Acnan it nnaalnm
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />AUTHORIZED REPRESENTATIVE
<br />n�Y-�aLr �'ruliLl
<br />y r coo-w 10
<br />tawrtu L:V K V V KA I ION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />251-53
<br />
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