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Francine R. Villareal Olatallyslgned by Francine fl.Vlllareal
<br />Hate: 2021.02.1014Aeal-0re0P
<br />TOAND-1 OP ID' KA
<br />, lft R CERTIFICATE OF LIABILITY INSURANCE
<br />�'�'�
<br />DATE/10/2 20
<br />12/10/2020
<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 858-457.5720
<br />Rubin insurance Agency Inc.
<br />CA Lie 0645355
<br />NTACT Michael Rubin
<br />PNONE
<br />AIC,
<br />858-457-5720 FAX 858-457.5729
<br />No, Ext): (A/C, No):
<br />5075 Shoreham Place, Suite 100
<br />San Diego, CA 92122
<br />Michael Rubin
<br />EMAIL
<br />, michae ru Inlnsurance.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIL#
<br />INSURER A: National Interstate Ins Co
<br />32620
<br />INSURED Standard Enterprises Inc
<br />Dba: To and Me Towing
<br />51aN Poinsettia St
<br />INSURER B:Golden Bear Insurance Co.
<br />39861
<br />Insurance Company of the West
<br />INSURER C: P Y
<br />27847
<br />Santa Ana, CA 92701
<br />INSURER D :
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER' RFVICIr1N NIIMRFI
<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 />Ila_A
<br />TYPE OF INSURANCE
<br />DOL
<br />SNSD UBS
<br />POLICYNUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />y
<br />TWT0000143.01
<br />06/0112020
<br />06101/2021
<br />EACH OCCURRENCE
<br />1,000,000
<br />PREMIITAMASES ca occ rr nce
<br />gpp,gpg
<br />MED EXP (Any oneperson)
<br />5,000
<br />PERSONAL &ADV INJURY
<br />1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY 0 PRO- LOC
<br />JECT
<br />GENERALAGGREGATE
<br />2,000,000
<br />GEN'L
<br />PRODUCTS - COMPIOP AGGIi
<br />2,000,000
<br />iDed
<br />0
<br />OTHER:
<br />A
<br />LIABILITY
<br />COMBINEDI SINGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJURY Per erson
<br />$
<br />ANYAUTO
<br />Y
<br />TWT0000143-01
<br />06/0112020
<br />06101/2021
<br />PUTOMOBILE
<br />OWNED X SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILYBOOpDILY INJURY Per accident
<br />$
<br />AMAGE
<br />$
<br />LRTOS ONLYXAUTOSONLYPe�accJOY
<br />Unin Motor
<br />B
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />GBX33002
<br />07/0112020
<br />06/0112021
<br />AGGREGATE
<br />$ 5,000,000
<br />DED X RETENTION$ 0
<br />C
<br />WORKERS COMPENSATION
<br />ANOEMPLOVERS'LIABILITY
<br />ANY PROPRIETORIPABILITYEXECUTIVE YIN
<br />PFFICERlMandaterMy � NH) EXCLUDED? 0
<br />Ryes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />Y
<br />WSD5020840-08
<br />04/0112020
<br />0410112021
<br />X PER OTH-
<br />E ER
<br />E.L. EACH ACCIDENT
<br />11000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />A
<br />GKLL
<br />TWT0000143-01
<br />06/0112020
<br />0610112021
<br />Ded $500
<br />500,000
<br />A
<br />On-Hook/Cargo
<br />TWT0000143-01
<br />06/01/2020
<br />0610112021
<br />Ded $1000
<br />100,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD IOf, Additional Remarks Schedule, may be attached if more space Is required)
<br />City of Santa Ana, its officers, employees, agents and representatives are
<br />named as additional insured with respects to general and auto liability of
<br />the named insured, pursuant to written contract, agreement or memorandum of
<br />understanding. Coverage is primary and non-contributory. Blanket general
<br />liability additional insured endorsement CG2010(0413) and primary and non -
<br />CITY025
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRI
<br />`"
<br />ACORD 25 (2016103) ©1988-2015 ACORD Cl
<br />The ACORD name and logo are registered marks of ACORD
<br />,,.ien,.,� RielcManagemertDtWalon �.
<br />REVIEWED&APPROVED BY:
<br />4 nFt.rNna z VcIG'a
<br />�I Risk Management Analyst
<br />
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