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A ,�Q CERTIFICATE OF LIABILITY INSVRANCe
<br />°A E(MMIOD Y Y>
<br />O7Hwoosn
<br />TFIIS CF RTI -ICATE IS ISSUEb AS A ALTER Up I FORMATION ONL AND CONFER NO RIGHTS V ON T E CE IF CATE OLDER. T IS
<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 />"
<br />PO TAN the card IDate, htil ew is an A DI7IONAL NSU ED, tho poliby(fea) must' Lave A ITI AL I RE provlslons or be endorsed. I
<br />SUBROGATION IS WAIVED, subject to the terms and conditions of tha PoGy, certain pollcles may require an endorsement. A statement on this
<br />certificate, does not confer rights to the certificate holder in lieu of such ondorsoment(s).
<br />PRODUCER
<br />AOn Risk Insurance Services Nest, Inc,
<br />LDS An eleS CA Office
<br />707 Wilshire Boulevard
<br />Suite 2600
<br />LOS Angeles CA 90017.-0460 USA
<br />OR -
<br />NAME.
<br />No. Nu. Ext: (866) PSS91T2 F Ms.), (800) 361-0105
<br />-^°----
<br />CDR ss,
<br />INSVRER(S) AFFORDING COVERAGE
<br />NAICR
<br />INSURED
<br />West Ctlaat Arbors Sts, Inc.
<br />2204 E via Burton
<br />^^-` -Company
<br />INSURER n: Starr xm amnity & Liability company
<br />......................_...._.r..-.,.........,....__.........._,,...............-...,..,an
<br />38318
<br />IxsuseR a: Starr Specialty Insurance Company
<br />1 109
<br />Andheim CA 92$06 050.
<br />INSVRER C:
<br />............_.�.��.,..._.-�................-._.............,..,...e....,..,.._...,.....__..............
<br />INSURER p:
<br />INSURER E:
<br />CfTVPRaf:RS rroT
<br />INSURER N
<br />THIS IS TO CERTIFY THAT THE POLICIES F I "SURANCE LISTS BEL HAV BEEN ISSUED TO THE INS RED NAMED A 0 E FOR HE OUCY PERK
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BF. ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED
<br />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
<br />CLAIMS. Limbs aNaWn are as to use ad
<br />ITa
<br />TYPE OF INSURANCE
<br />No
<br />POLICYNUMaER
<br />M
<br />LIMRs
<br />%
<br />COMMERCM0ENERALLIAaIDDY,
<br />EACH OCCURRENCE
<br />$2,JOB
<br />CLAIMO•MADE 0OCCUR
<br />,000
<br />PR MIS
<br />$1, 0OO, ODD
<br />MEOEXP(Anyooap..)
<br />-� $5,000
<br />PERSONAL ADV INJURY
<br />S210001000
<br />DEN'LAOGRED^A1�TET' I(MrfAPPUES PER
<br />POLICYI�.lJ 0C0a El LOU
<br />GENERN.AGGREGATE
<br />....d S4,000,000
<br />PRODUCTS�COMPIOPAGG
<br />E4,000,00D
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABUTY
<br />100019 R198201
<br />07/01/202007/01/2021
<br />COMBINED SINOLE LIMIT
<br />-
<br />E2,DOD,DOD
<br />X ANYAUTO
<br />BODILY INJURY (Pat Eamon)
<br />OWNED SCHEDAUTOS�O
<br />((CDAUTOS NLY
<br />BODILY INJURY (Par acCWenp-^�-
<br />PROPERTY DAMAOE
<br />ONLY AUTOS ONLY
<br />ONLYUTOE AUTO$ONOILOWNLY
<br />Pwancidnnl
<br />UMORELLALkia
<br />OCCUR
<br />EACHOCCURRENCE
<br />EXCESS LIAR
<br />CLAIM&MARE
<br />AGGREGATE
<br />DEB
<br />RETENTION
<br />A
<br />WORKERS COMPENSATION AND
<br />1000004229
<br />D 1
<br />0i
<br />EMPLOYERS' LIABILITY
<br />wOrkBl'S Comp AZ
<br />X PER STATUTE DTN•
<br />B
<br />ANY PROPRIETOR, WATNER, E$EOUTn,D
<br />oFFmERrMEMaEReXCLUB#a+ M
<br />NIA
<br />1000004228
<br />07101/2020
<br />07/01/2021
<br />EL EACHACIOENT
<br />E11000,000
<br />0pndalary In NlO
<br />ay ae,deocoha TD
<br />workers COmp CA
<br />EL. CISEASE-EAEMPLOYEE.
<br />S1,000,0DO
<br />DESCRIPTION OF OPERATIDN$Rpk.
<br />E L. DISRASE-POLICYLIMtr
<br />E1, ODDr BOO=
<br />'
<br />OESCRIPY*N OFOPERATIONS I LDCATIONS I VEHICLES CACORU tat, Addillpnel Rampeka Schadpim mny De YtbeAatl N mwY space h raqulrotll
<br />RE: All lobs performed by the named insured during the policy term. city of Santa Ana, its officers, employees, agents, volunteers
<br />and representatives are included as Additional Insured in accordance with the policy provisions of the General Liability policy. General Liability policy evidenced hereinis
<br />primary and uon-Contributory to other insurance available to an
<br />Additional Insured, but only in accordance with the policy's provisions.
<br />i
<br />]?EV!W Y � APPROVED
<br />R' • h
<br />CERTIFICATE HOLDER 0V !S +tNACr£MENT 11ft. l4MLLATION =-
<br />City of Santa Ana It
<br />RiS Management Division `
<br />20 Civic Center Plaza, 4th
<br />Santa Ana CA 92701 USA
<br />ACORD 25 (2016103)
<br />THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE THE
<br />THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />01988.2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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