|
In"Y
<br />Francine R, Villareal lb,,ai Hance err,amne R.
<br />Dace: xonns.reosn:n
<br />HUNS&AS-01 sroor
<br />BLE NGER
<br />,4�co�ro CERTIFICATE OF LIABILITY INSURANCE
<br />DAT511412014/2021 21
<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 License # OM70471
<br />N%JACT Arlene Blechinger
<br />Orlon Risk Management Insurance Services, An Alera Group Insurance
<br />Agency, LLO
<br />1800 4uail Street Suite 110
<br />Newport Beach, CA 92660
<br />PHONE 1 Ix, No ;(g49) 263-6860
<br />(Alc, No, Ext): (949) 377-0078
<br />:AE . ablechinger@orionrisk.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA:The Hartford Fire Insurance Company
<br />19682
<br />INSURED
<br />INSURER B: THE HARTFORD CASUALTY INSURANCE COMPANY
<br />29424
<br />INSURER C :
<br />Hunsaker & Associates Irvine, Inc.
<br />3 Hughes
<br />Irvine, CA 92618
<br />INSURER D :
<br />INSURER E:
<br />INSURER F :
<br />COVERAGES CERTIFICATE NIIMRPP- noAnclokl NU INaGco.
<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 />ILT.NSR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />pOLICYNUMBER
<br />POLICY EFF
<br />D
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE �X OCCUR
<br />X
<br />72UUNOL5213
<br />10/1/2020
<br />101112021
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTEDPREWM5 (Ed
<br />300,000
<br />MEO UP (Any onePerson)
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑X YEST [:]LOC
<br />OTHER; No Deductible Applies
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMPIOP AGO
<br />$ 2,000,000
<br />EMPLOYEE BNFTS
<br />21000,000
<br />B
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />OWNED
<br />OWNED SCHEDULED
<br />ONLY SCHEDULED
<br />E
<br />ZRI'OS ONLY AUTOS ONLY
<br />X
<br />72UENOL5251
<br />101112020
<br />10/1/2021
<br />EOMBINEED SINGLE LIMIT
<br />$ 1,000,000
<br />$
<br />BODILYINJURYPerperson)
<br />BODILY INJURY Per accident
<br />$
<br />R
<br />PerOaCcdent WAGE
<br />$
<br />B
<br />JX
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />72XHUOL5168
<br />101112020
<br />10/1/2021
<br />EACH OCCURRENCE
<br />$ 8,000,000
<br />AGGREGATE
<br />$ 8,000,000
<br />DEO X RETENTION$ 10,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />PARTNE
<br />OA0NYCED(,MEETO�RpIEXCLUDR/EXECUTIVE
<br />`MandatwoM nNH EXCLUOEDT
<br />yl 1 If describe under
<br />Dyes,
<br />DESCRIPTION OF OPERATIONS below
<br />N1A
<br />72WEOL6HIX
<br />101112020
<br />101112021
<br />X PER OTH-
<br />ST ER
<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 />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />RE: Santiago Park Main ST Entrance
<br />City of Santa Ana, officers, agents, employees, and volunteers are named as additional insured on a primary & non-contibutory basis per the terms of the
<br />attached General Liability & Auto Liability endorsements.
<br />30 Days Notice of Cancellation; 10 Days Notice for non-payment of premium apply per policy provisions.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE WRiekManagemexxEDlWelgn
<br />REVIEWED&A'PROVEDBY:
<br />ACORD 25 R v�ii� ,4t
<br />2016/03 c
<br />( ) O 1988-2015 ACORD C
<br />The ACORD name and logo are registered marks of ACORD--' auk Management Analyst
<br />
|