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rranane h. Francine RVillareal <br />Date: 1020.09.02 <br />Villareal <br />10:18:53-07'00' <br />A166 0 CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMI12020 Y) <br />OB/3112020 <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 hostler is an ADDITIONAL INSURED, the policy(ies) 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 />AOn Risk services Northeast, Inc. <br />New York NY Office <br />CONTACT <br />NAME: <br />PHONE (g66) 283-7122 FAX (800) 363-0105 <br />(AIC.No.Ea): AIC. Md.: <br />One Liberty Plaza <br />165 Broadway, suite 3201 <br />E-MAIL <br />ADDRESS: <br />New York NY 10006 USA <br />INSURER(S) AFFORDING COVERAGE <br />NAIL# <br />INSURED <br />INSURER A: National union Fire Ins CO of Pittsburgh <br />19445 <br />Los Angeles SMSA LP <br />chat verizon wireless <br />INSURER B: AIU Insurance company <br />19399 <br />INSURER C: American Home Assurance Co. <br />19380 <br />1095 Avenue of the Americas <br />New York NY 10036 USA <br />INSURER D: New Hampshire Insurance Company <br />23841 <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 570083738856 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. Limits shown are as requested <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />I <br />INSD <br />SUER <br />WVD <br />POLICY NUMBER <br />MPOLICY Err MIODIYYYY <br />MMIDD'YYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />Y <br />GL <br />EACHOCCURRENCE <br />12,000,003 <br />CLAIMS -MADE MOCCUR <br />PREMISES Ea occurrence <br />$2,000,000 <br />X <br />MED EXP(Any one person) <br />$10,000 <br />XCU Coemgeis Included <br />PERSONAL IL ADV INJURY <br />12,000,000 <br />GEN'LAGGREGATE LIMITAPPLIES PER: <br />GENERALAGGREGATE <br />15.000,000 <br />X POLICY ❑ PRO JECt ❑ LOC <br />PRODUCTS-COMPIOPAGG <br />$5,000,000 <br />OTHER: <br />A <br />AUTO MOBILE LIABILITY <br />CA 4194291 <br />ADS <br />01/30/202006/30/2021 <br />COMBINED SINGLE LIMIT <br />Ea 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 />RIREDAUTDB NON -OWNED <br />ONLY AUTOS ONLY <br />MA <br />CA 4594300 <br />VA <br />06/30/2020 <br />06/30/2021 <br />BODILY INJURY (Par acudent) <br />PROPERTY OAMgGE <br />Peraccitlent <br />A <br />See Next Page <br />06/30/2020 <br />06/30/2021 <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />EXCESS LIAB <br />CLAIMS -MADE <br />AGGREGATE <br />DED <br />RETENTION <br />B <br />O <br />WORKERS COMPENSATION AND <br />EMPLOYERTLIABILITY YIN <br />ANY PROPRIETOR) PARTNER I EXECUTIVE <br />OFFICEROAEMBER EXCLUDED? N <br />NIA <br />WC045886576 <br />ADS <br />wC045886575 <br />06/30/2020 <br />06/30/2020 <br />06/30/2021 <br />06/30/2021 <br />X PER STATUTE I <br />I <br />OTH- <br />ER <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />E.L. DISEASE -EA EMPLOYEE <br />$1,000,000 <br />(Mandatary In NH) <br />CA <br />If yes, descries under <br />DESCRIPTION OF OPERATIONS be. <br />EL DISEASE POLICY LIMIT <br />$1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached a 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 />CERTIFICATE HOLDER CANCELLATION <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 <br />Risk management Division <br />20 Civic Center Plaza, 4Ih Floor <br />Santa Ana en 92701 USA <br />AUTHORIZED REPRESENTATIVE <br />0.Jr/ aViNHbi�� <br />Risk Merrgemmt <br />Dmision <br />©1988-2015 ACORD CO <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />APPROVED REVIEWED 68Y. <br />rR'' <br />Risk Managenavrt Malys) <br />