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Francine R. Digitally signed by FrancineR. <br />Villareal <br />�1 isr VIIldred l <br />AC©R CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <br />01/11/2021 <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 endorsement(s). <br />PRODUCER Cornish Insurance <br />CONracr NAME: Blake Cornish <br />8816 South Sepulveda Blvd, Ste 108 <br />OIN <br />aCC No EXt: 310-215-3638 FAXNo:310-496-0627 <br />E-MAIL ADDRESS: blake@cornishinsurance.com <br />Los Angeles CA 90045 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURERA: Northfield Insurance Company <br />27987 <br />INSURED Sensemakers LLC <br />INSURERB: Truck Insurance Exchange <br />21709 <br />2401 East Katella Ave Ste 610 <br />INSURERC: National Union Fire <br />Anaheim CA 92806 <br />INSURERD: USLI <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 <br />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 />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/Y <br />POLICY EXP <br />MM/DD <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />WS438940 <br />11/28/2020 <br />11/28/2021 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />❑✓ <br />TO <br />DAMACLAIMS-MADE <br />50,000 <br />OCCUR <br />PREMISES Ea occurrence <br />PREMISES cc."..C.) <br />$ <br />MED EXP (Any one person) <br />$ 5,000 <br />✓ <br />CGL- Per Occurance <br />A <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />YGEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />POLICY ❑ PRO JECT ❑ LOC <br />✓ <br />PRODUCTS - COMP/OP AGG <br />$ 1,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />AUTO <br />BODILY INJURY (Per person) <br />$ <br />eANY <br />OWNED SCHEDULED <br />BODILY INJURY (Per accident) <br />$ <br />AUTOS ONLY AUTOS <br />PROPERTYDAMAGE <br />Per accident <br />$ <br />uHIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />lul u <br />$ <br />1 V <br />I UMBRELLALIAB <br />0 <br />OCCUR <br />El <br />D <br />EACH OCCURRENCE <br />$ 1,000,000 <br />C <br />EXCESS LAB <br />u <br />CLAIMS -MADE <br />EBU 064522034 <br />06/16/2020 <br />06/16/2021 <br />AGGREGATE <br />$ 1,000,000 <br />IJ <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />STATUTE ER <br />AND EMPLOYERS' LIABILITY Y / N <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />B <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />A09599357 <br />05/09/2020 <br />05/09/2021 <br />OFFICE R/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />N/A <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />1 000 000 <br />$ r r <br />Each Occurrence <br />$2,000,000 <br />C <br />Professional Liability <br />0 <br />SP1572206 <br />11/28/2020 <br />11/28/2021 <br />Aggregate <br />$2,000,000 <br />00 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />City of Santa Ana, its officers, employees, agents and representatives are additional insured with respect to general liability per attached <br />endorsements as required by written contract. Insurance is primary and non-contributory. Wavier of Subrogation applied to workers <br />compensation. <br />30 days Notice of Cancellation with 10 days notice for non-payment of premium in accordance with the policy provision. <br />CERTIFICATE HOLDER <br />CANCELLATION Risk ManagmwdDivisian <br />CITY OF SANTA ANA <br />�� REVIEWED&RPPROV67BY. <br />' <br />Risk Management Division <br />SHE U D ANY U <br />DAABOVE <br />THEREOF,DESCRIBE[ <br />TOIONTHE <br />20 CIVIC CENTER PLAZA 4th Floor <br />ACCORDANCE WITH THE POLICY PROVI Risk Management Analyst <br />SANTA ANA, CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />Blake Cornish <br />F/V <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />