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Francine R,
<br />Villareal $e OP ID: YC
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />1
<br />Dg 1111312020
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsements .
<br />PRODUCER
<br />Narver Associates Ins Agcy
<br />P.O. Box 1509
<br />San Gabriel, CA 91778-1509
<br />Wesley G. Hampton
<br />CONTACT June Samaria
<br />NAME:PHONE
<br />FAX
<br />A/C No Ext:626-943-2200INCNo:
<br />nooAILSS: Jsamarin narver.com
<br />PRODUCER
<br />CUSTOMER ID a: GRUEN-1
<br />INSURERS AFFORDING COVERAGE
<br />NAILA
<br />INSURED Gruen Associates"'
<br />6330 San Vicente Blvd., $ 200
<br />Los Angeles, CA 90048
<br />INSURERA:Valley Forge Insurance Company
<br />20508
<br />INSURERS: Continental Casualty Company
<br />20443
<br />INsuRERc:National Fire Insurance Co
<br />20478
<br />INSURERD:American Casualty Company
<br />204Z7
<br />INSURER E
<br />NSURER F :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR-
<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.
<br />INSR
<br />LT,
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICYEXP
<br />MM/DD/YYYV
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I A OCCUR
<br />X
<br />X
<br />6025612892
<br />O6/01/2020
<br />06/01@021
<br />A EEST0 RENT
<br />PREMISEa occurrence
<br />$ 1,000,000
<br />MED EXP(Any one person)
<br />S 10,00
<br />PERSONAL B ADV INJURY
<br />S 1,000,000
<br />GENERAL AGGREGATE
<br />S 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMPIOP AGG
<br />S 2,000,000
<br />POLICY X PRO LOC
<br />S
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(Ea seddent)
<br />5 1,000,000
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />S
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Per acadenl)
<br />S
<br />C
<br />X
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />6025604615
<br />06101/2020
<br />06/0112021
<br />PROPERTY DAMAGE
<br />IPER ACCIDENT)
<br />S
<br />C
<br />X
<br />NON-OWNEDAUTOS
<br />6025604615
<br />06101/2020
<br />06/01/2021
<br />S
<br />S
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />S 10,000,000
<br />B
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />6025612973
<br />06101/2020
<br />06/01/2021
<br />DEDUCTIBLE
<br />g
<br />X
<br />RETENTION $ 10,000
<br />1
<br />g
<br />D
<br />WORKERS COMPENSATION
<br />ANO EMPLOYERS' DABILITY YIN
<br />ANFICERMEMBEREXQfIERiE ECUTIVE
<br />NIA
<br />X
<br />6025612939
<br />06101/2020
<br />06/0112021
<br />WC STATU- OTH-
<br />X T ER
<br />E.L EACH ACCIDENT
<br />S 1,000,000
<br />E.L. DISEASEEAEMPLOYEd
<br />S 1,000,000
<br />(Mandatory in NH)
<br />If yes. describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />I S 1,000,000
<br />B
<br />Professional
<br />AEH-008215536
<br />06/0112020
<br />06101/2021
<br />Per Claim 6,000,000
<br />Liability
<br />Aggregate 5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
<br />City of Santa Ana, its officers, employees, agents, volunteers and
<br />representatives are additional insured on a primary and non-contributory
<br />basis as respects attached General Liability endorsement SB146932, as
<br />reMu ed by contract. Waiver of subrogation applies as per attached General
<br />Liability form SB146932 and Workers Compensation form G19160. Separation of
<br />CITYSAN
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CI of Santa Ana
<br />City
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL
<br />BE DELIVERED IN
<br />Risk Management Division
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza 4th Fir
<br />Santa Ana, CA 92702
<br />AUTHOmiED REPRESENTATIVE
<br />�
<br />rREVIEWED
<br />ru
<br />b, APPROV®BY:©
<br />1988-2009 ACORD CO
<br />F —lwl a.e R. vtuilnu�ACORD
<br />25 (2009109)
<br />The ACORD name and logo are registered marks of ACORD
<br />Risk Management analyst
<br />
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