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Francine R. Dlmnuy signed by Francine
<br />N.VIIIa.1
<br />Villareal Date: 2020.00.0410:19:34
<br />ACC7R[7� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDTYYYI)
<br />THIS CERTIFICATE IS ISSUED AS AMATTER 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 CONSTITUTEA 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 be endorsed. IT SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain. policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsoment(s).
<br />PRODUCER
<br />CONTACT Yolanda Medina
<br />NAME:
<br />F and I Inassranae .Services, Inc.
<br />99 Long Cit.
<br />PHOfE (805)496-6555 A (sos)497-§eTo
<br />AC No :
<br />E4dAIL ymedina@fendiinsuranae.com
<br />ADDRE93:
<br />Suite 201
<br />INSURERS AFFORDING COVERAGE
<br />NAIC A
<br />INSURERA: Philadelphia Indemnity Insurance Compeer
<br />18058
<br />Thousand Oaks CA 91360
<br />INSURED
<br />INSURER B: Preferred Employers Insurance
<br />10900
<br />INSURER C_ColU1ft is Casualty Company
<br />31127
<br />M.T. X-Ray, Inc.
<br />DBA: Modern Technology School
<br />INSURER D:
<br />16560 Harbor Blvd Suite K
<br />INSURER E:
<br />Fountain Valley CA 92708
<br />INSURERF:
<br />UVVERAGED OtKIIFICAIt NUMtltKIZU-Zl 01,AU,WC,XS,EPL 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM$
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />ILTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SD
<br />6
<br />POLICY NUMBER
<br />CV EFF
<br />MIDDIYYYY
<br />POLICY
<br />I'YYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGPREMISESE ra
<br />NIED-_�.
<br />IE9Le
<br />$ I0D,000
<br />MED EXP(Any one person)
<br />$ 5,000
<br />X
<br />PHPK2112362
<br />5/17/2020
<br />5/17/2021
<br />PERSONAL &ADV INJURY
<br />It 1,000,000
<br />GEN'LAGGREGATE LIMITAPFLIES PER:.
<br />X POLICY O LOT LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINEDSIR-GIFETIPT
<br />Ed ar ident
<br />If 1,00D,000
<br />BODY INJURY (Per. mrson)
<br />_
<br />$
<br />A
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />PHEK2112362
<br />5/17/2020
<br />5/17/2021
<br />Per
<br />BODILY INJURY accident
<br />( )
<br />$
<br />X
<br />N040VVNED
<br />HIREDAUTOS X AUTOS
<br />PROPERTY DAMAGE
<br />Pe accident
<br />$
<br />$
<br />X
<br />UMBRELLALIAB
<br />IX
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 11000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />A
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />LED
<br />X RETENTION $ 10,000
<br />$
<br />ee06715646
<br />5/17/2020
<br />5/17/2021
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' UABILITY YIN
<br />ANY PROPRIETORlPARTNERHXECUTIVE
<br />OFFICFRIMEMBERE$CILDED9NH) y
<br />(Mandaboryit
<br />IF yes, describe under
<br />NIA
<br />MN147176-B
<br />7/1/2020
<br />7/l/2021
<br />X R T -
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000 000
<br />EL.DISEASE-POLICY LIMIT
<br />$ 1, 000,000
<br />DESCRIPTION OF OPERATIONS below
<br />'A
<br />Employment Practices Liability
<br />PHED1542928 (claims made form)
<br />5/17/2020
<br />5/17/2021
<br />$1MIU§1MLcaohdslm's00 Dad: $25,000
<br />C
<br />Professional Liability
<br />411936524 (claims Made Form)
<br />7/20/2019
<br />7/20/2020
<br />$1MIV$61,1I1-occurlagg
<br />DESCRIPTION OP OPERATIONS I LOCATIONS I VEHICLES (ACORD101, Additional Remarks Schedule, maybe attached if mere apace 1s required)
<br />The City of Santa Ana, its officers, smployees, agents, volunteers and representatives are named as
<br />Additional Insured with respects to the General Liability per form #PI-GLD-VS (05/17)
<br />*10 days notice of cancellation applies to non-payment of premium, 30 days all other,
<br />CERTIFICATE HOLDER CANCELLATION ---
<br />AGoodson@santa-ana.org
<br />City of Santa .Ana
<br />Risk Management Division, 4th Floor
<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 REPRESENTATIVE
<br />COX, Jr./YOLI
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />INS025 (201401)
<br />,��., RtakM4nagemoltD[Wal9n
<br />AR' EVIEWE
<br />D&APeP'ROVEDBY:
<br />Al
<br />SI rI1x 15 f,%*Pow R. Y
<br />Rnk Mai mi Analyst
<br />
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