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rrancme K. Francine R. Villareal <br />Villareal Date: 1120.09.02 <br />10:18:53-07'00' <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMODf/ VV) <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 holder 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 />Ann Risk Services Northeast, Inc, <br />New York NY office <br />CONTACT <br />NAME: <br />PHONE (Bfifi) 283-7122 FAx (800) 363-0105 <br />INC. No. EXq:INC. No.: <br />One Liberty Plaza <br />165 Broadway, Suite 3201 <br />E-MAIL <br />ADDRESS: <br />New York NV 10006 USA <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />INSURERA: National Union Fire Ins CO of Pittsburgh <br />19445 <br />LOS Angeles SMSA LP <br />dba verizon wireless <br />INSURER B: AID Insurance Company <br />19399 <br />INSURER Ca American Home Assurance Co. <br />19380 <br />1095 Avenue of the Americas <br />rvew 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 />LTR <br />TYPE OF INSURANCE <br />INSD <br />WVD <br />POUCYNUMBER <br />QMMIDDIYYYYI <br />fMMIDDfYYYYILIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />Y <br />Y <br />GL <br />EACH OCCURRENCE <br />$2,000,000 <br />CLAIMS -MADE ❑X OCCUR <br />V ENTED <br />PREMISES Ea occurrence <br />$2,000,000 <br />X <br />MED EXP (Any one person) <br />$10, 000 <br />XCU Coverage is Included <br />PERSONAL B ADV INJURY <br />$2,000,000 <br />GEN'LAGGREGATE LIMITAPPLIES PER: <br />GENERALAGGREGATE <br />$$,000,000 <br />PRO LOD <br />X POLICY ❑ JE <br />PRODUCTS-COMPIOPAGG <br />15,000,000 <br />OTHER: <br />A <br />LIABILITY <br />CA 4594298 <br />ADS <br />06/30/2020 <br />06/30/2021 <br />COMBINED SINGLE LIMIT <br />Ea accidenti <br />$1,000,000 <br />BODILY INJURY( Per person) <br />A <br />NOCA <br />4594299 <br />06/30/202006/30/2021 <br />AUTNLYAUTOS <br />FMiO <br />WSCHEDULED <br />NLY AUTOS ONLY <br />MA <br />CA 4594300 <br />VA <br />06/30/2020 <br />06/30/2021IREDAUTOSNON-0WNED <br />BODILY INJURY(Per accident, <br />PROPERTYDAMAGE <br />Peraccitlent <br />A <br />ISee Next Page <br />06/30/2020 <br />06/30/2021 <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE <br />EXCESS LIAR <br />H <br />CLAIMS -MADE <br />AGGREGATE <br />DED <br />RETENTION <br />B <br />C <br />WORKERS COMPENSATION AND <br />EMPLOYERS'LIABILITY YIN <br />ANY PROPRIETOR I PARTNER' EXECUTIVE <br />OFFICERMIEMBER EXCLUDED? <br />(Mamlamry in NH) [flNIA <br />wc045886576 <br />ADS <br />WCDQ$886575 <br />CA <br />06/30/2020 <br />06/30/2020 <br />06/30/2021 <br />06/30/2021 <br />X <br />I PER STATUTE OTH- <br />ER <br />EL EACH ACCIDENT <br />$1,000,000 <br />El DISEASE EA EMPLOYEE <br />$1.000, 000 <br />DEdescosteurder <br />SCRIPTION OF OPERATIONS below <br />EL. DISEASE -POLICY LIMIT <br />$1,000,000 <br />DESCRIPTION OF OPERATIONS / 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 AUTHORIZED REPRESENTATIVE <br />Risk Management Division <br />20 civic center Plaza, 4th Floor 1 ls� <br />Santa Ana en 92701 USA c(/y <br />rN e_..sQe Risk MmagO110d Divison <br />©1988-2015 ACORD CO o REAEwED S APPRovm Sr. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ,I',®� /'�'" F'Ktr�H P, V�Ct <br />�--� RISK Management Analyst <br />