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7 ion rierson a e:2621--2814:572 7-
<br />q R� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DDNYYY)
<br />09/03/2021
<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 be endorsed. If 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 endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME: S I LV I CHA
<br />INSURANCE LAND INSURANCE SERVICES
<br />PHONE 213-388-5505 F 213-388-7148
<br />A/C No Ext : A/C No
<br />E-MAIL ADDRESS: INSURANCELAND@GAMIL.COM
<br />4032 WILSHIRE BLVD
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />STE 309
<br />INSURER A: EVANSTON INSURANCE CO
<br />35378
<br />LOS ANGELES CA 90010
<br />INSURED
<br />INSURERB: PROGRESSIVE INSURANCE CO
<br />27804
<br />VALLEY MAINTENANCE CORPORATION
<br />INSURERC:UNITED STATES LIABILITY INS CO
<br />25895
<br />INSURER D: I CW GROUP
<br />27847
<br />INSURER E: TRAVELERS CASUALTY AND CURETY CO
<br />19038
<br />11759 TELEGRAPH ROAD
<br />INSURER F:
<br />SANTA FE SPRINGS CA 90670
<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 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 />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE © OCCUR
<br />3AA496137
<br />08/13/2021
<br />08/13/2022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 100,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PRIMARY NON-CONTRIBUTORY
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />A
<br />X
<br />X
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY PRO ❑ LOC
<br />JECT
<br />PRODUCTS-COMP/OPAGG
<br />$ INCLUDED
<br />$ 25,000
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />03/12/2021
<br />03/12/2022
<br />EaaccldeDSINGLELIMIT
<br />COMB03370309-0
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />B
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />X
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />UMBRELLA LIAB
<br />OCCUR
<br />XL1578400C
<br />05/02/2021
<br />05/02/2022
<br />EACH OCCURRENCE
<br />$ 5,000, 000
<br />AGGREGATE
<br />$ 5,000, 000
<br />C
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />PRODUCTS-COM/OP AGG
<br />$ 1,000,000
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? Y
<br />(Mandatory in NH)
<br />N / A
<br />X
<br />WSA5037498-03
<br />08/13/2021
<br />08/13/2022
<br />PER OTH-
<br />STATUTE I I ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1 , 000, 000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />I $ 1,000, 000
<br />E
<br />CRIME
<br />105620659
<br />05/24/2021
<br />05/24/2022
<br />THIRD PARTY $1, 000, 000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space Is required) Agreement Number ; A-2021-043
<br />City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract,
<br />agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City
<br />shall be excess and noncontributory."
<br />This Policy may be canceled by the Company by giving to the Insured and to the additional insureds Indic ated on the certificates of insurance
<br />issued during the term of this policy, at least Thirty (30) days written notice of cancellation or in the case of non-payment of premium, at least
<br />ten (10) days' written notice of cancellation."
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th floor
<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 />C_ R�vi� tavm
<br />©1988-2014 ACORD CORF sup 7a a�er��=
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Risk NFanagemmraen ral/4de
<br />
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