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Dl11l ayslgretl Cy FantlneR
<br />Francine R. Villareal Ylle,e,l
<br />/_qN STETS-1 ""` p° 1
<br />'4� R� CERTIFICATE OF LIABILITY INSURANCE DATE 3/2021Y)
<br />02103/2021
<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 endorsements .
<br />PRODUCER 888-420-1967
<br />InsPro. Rhonda Buck
<br />Insurance Services
<br />4020 Moorpark Avenue, #104
<br />San Jose, CA 95117
<br />CONrncT Inspro Agents&Brokers Ins Sery
<br />PHONE 888-420-1967 FAX 408-241-0037
<br />(A/C, No, Ezt): (AIC, No):
<br />E-MAIL
<br />ESS:
<br />INSUREFUSI AFFORDING COVERAGE
<br />NAIC If
<br />Inspro Agents&Brokers Ins Be"
<br />INSURER A : Hanover American Ins Co#36064
<br />MNS RE
<br />Engineers Inc. 2171 E. Francisco §lvd, Ste. K
<br />2171 E.
<br />San Rafael, CA 94901
<br />INSURERS : U.S. Specialty Ins. Co. #29599
<br />INSURER G Allmerica Financial Ben.#41840
<br />INSURER D
<br />INSURER E :
<br />INSURER F :
<br />COVFRAr7FS CFRTIFIRATF MIIMRFR- oesncrnM anraaove.
<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 />TYPE OF INSURANCE
<br />IN DOL
<br />UBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />07/01/2021
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />OZFD95532201
<br />07/01/2020
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES (Ea accurrencOMED
<br />$ 300000
<br />EXP (Anyone erson
<br />$ 10,000
<br />PERSONAL&ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY El wf LOG
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />PRODUCTS - COMP/OP AGG
<br />2,000,000
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED accident,SINGLE LIMIT
<br />$ 1 ggg ggg
<br />X
<br />BODILY INJURY Per persorn
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLYNAUTOS
<br />AWFD95530601
<br />07/01/2020
<br />07/01/2021
<br />BODILY INJURY Per accident)$
<br />X
<br />AUTOS ONLY AUUTOS ONLY
<br />PeOaccltl nDAMAGE
<br />$
<br />A
<br />UMBRELLA LIAR
<br />M
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 3,000,000
<br />AGGREGATE
<br />1 3,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />OZFD95532201
<br />07/01/2020
<br />07/01/2021
<br />DED IXI RETENTION$ O
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE
<br />)EXCLUDED?
<br />(Mandatoryln
<br />qMandaRry InNH)
<br />Dyes, describe under antl
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />WZFD92893201
<br />07/01/2020
<br />07/01/2021
<br />X PER OTH-
<br />E
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE -EA EMPLOYE
<br />$ 1,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />1,000,000
<br />B
<br />Professional Liab.
<br />USS2030941
<br />07/01/2020
<br />07/01/2021
<br />Ea. Claim
<br />2,000,000
<br />Deductible$50,000
<br />Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />30 day notice of cancellation except 10 days when for nonpayment of premium.
<br />City of Santa Ana its officers, employees, agents and representatives are
<br />additional insured as required by written contract with
<br />respect to operations of the named insured per form 3911006 and 4610478
<br />attached. Waiver of subrogation per attached WC040306.
<br />City of Santa Ana
<br />Risk Mgmt Division
<br />20 Civic Center Plaza 4th Fir
<br />Santa Ana, CA 92701
<br />CITY-15
<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 />ACORD 25 (2016/03)
<br />©1988.2015 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />F4k*�;: Z W&Vd
<br />Risk Management Analyst
<br />
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