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<br />D 10/29/2020 Y)
<br />10/2912020
<br />ACORO CERTIFICATE OF LIABILITY INSURANCE
<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.
<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 certificate holder in lieu of such endorsements .
<br />PRODUCER
<br />CONTACT Laura Morgan
<br />Alllant Insurance Services, Inc.
<br />3977 Harbour Pointe Blvd SW
<br />Mukilteo, WA 98275
<br />PHONEo FAX
<br />NEkt : (425 740-5207 AIC, No):
<br />E-MAIL . Laura.Morgan@alliant.com
<br />bD
<br />INSURERS AFFORDING COVERAGE
<br />NAC#
<br />INSURER A: Underwriters at Lloyd's London Illinois
<br />15792
<br />INSURED
<br />INSURERS: American Fire and Casualty Company
<br />24066
<br />INSURERC: Evanston Insurance Company
<br />36378
<br />Ergometrics & Applied Personnel Research, Inc.
<br />INSURER D
<br />2122 164th St. SW, Suite 300
<br />Lynnwood, WA 98087
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 />LTR
<br />TYPE OF INSURANCE
<br />ADO
<br />SUB
<br />POICVNUMBER
<br />POLICY EFF
<br />MM DO
<br />POLICY EXP
<br />MM DD
<br />LIMITS
<br />A
<br />X
<br />COMMERCIALGENERALLIABILITY
<br />CLAIMS -MADE E] OCCUR
<br />X
<br />PSJO022461715
<br />10/2712020
<br />1012712021
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />Es pcccrrarce�
<br />250,00PREMISES
<br />$
<br />MED E P Any oneperson)
<br />5,000
<br />PERSONAL & ADVINJURY
<br />$ 1,000,000
<br />GEN'LAGGREGAE LIMITAPPLIES PER
<br />X POLICY %,OT El LOD
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMP/OP AGG
<br />S 1,000,000
<br />S
<br />OTHER
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />S 1,000,000
<br />BODILY INJURY Per mrsom
<br />X
<br />ANY AUTO
<br />BAA 58229925
<br />1012712020
<br />1012712021
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />SSWNEp
<br />BODILY INJURY Per accident
<br />PR,..,d DAMAGE
<br />Per PER- nt
<br />AMODS ONLY AUTOS ONLV
<br />C
<br />X
<br />UMSRELLAIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />2,000,000
<br />AGGREGATE
<br />2,000,000
<br />EXCESS IAB
<br />CLAIMS -MADE
<br />XOBW8758420
<br />10/27/2020
<br />10/27/2021
<br />OEO I X I RETENTIONS 10,000
<br />A
<br />AND EMPLOYCOMPENSATION
<br />ERS' IASILIITY
<br />Y/N
<br />ANY PROPRIETORIPARTNERIEXECUTIVE ❑
<br />ppFFICER/MEMBER EXCLUDED?
<br />(mandatory in NHi
<br />NIA
<br />PSJO022461715
<br />10/27/2020
<br />10/27/2021
<br />PER X OTH-
<br />I
<br />E.L. EACH ACCIDENT
<br />11000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />1,000,000
<br />I yes describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />A
<br />PROFESSIONAL LIAB
<br />PSJO022461715
<br />10/27/2020
<br />1012712021
<br />EACH OCCURRENCE
<br />2,000,000
<br />A
<br />DEDUCTIBLE: $5,000
<br />PSJO022461715
<br />1012712020
<br />10127/2021
<br />AGGREGATE
<br />3,000,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES IACORD 101, Additlonal Remarks Schedule, maybe attached if more space Is required)
<br />RE: NTN Testing Services
<br />City of Santa Ana its officers, employees, agents and representatives are Additional Insured with respect to General Liability for Ongoing Operations of the
<br />Named Insured as required by written contract. General Liability coverage is Primary Non -Contributory. Notice of Cancellation, Non -Renewal and Material
<br />Change on General Liability and Professional Liability applies.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cityof Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />Risk MimagemmtDidslon
<br />_ RENEWED & APPROVED BY:
<br />©ACORDc ' f'NL.f.eL . V�lt� JZ• f
<br />ACORD 25 (2016103) 1988-2015
<br />The ACORD name and logo are registered marks of ACORD Ruk Management Analyst
<br />
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