|
'19 CERTIFICATE OF LIABILITY INSURANCE I DATE 0/083/08l//2021
<br />��
<br />THIS CERTIFICATE 15 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 TE
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUINBY THE POLICIES
<br />G ORDER R(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcyp") 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 ondomement s .
<br />NAMgPRODUCER
<br />INSURANCE LAND INSURANCE SERVICES PHONE STLVI CHA
<br />wlc, No_EM1. 213-388 5505 Ile/c..Na1. 213-388 7148
<br />WILSHIRE4032 BLVD E0E INSURANCELAND@GMAIL. COIN
<br />ADDRESS
<br />SUITE 3O9 INSURER(S) AFFORDING COVERAGE NAICK
<br />LOS ANGELES CA 90010 -- i
<br />INSURED INSURER B: STATE FARM 11770
<br />VALLEY MAINTENANCE CORPORATION INsuRERc:TWITED STATES LIABILITY INS. In 25895
<br />11759 TELEGRAPH ROAD INSURER O ICN GROUP 27847
<br />-
<br />wsuRERE TRAVELERS CASUALTY AND SURETY Co, 19038
<br />SANTA FE SPRINGS CA 90670 INSURER F:
<br />Cr1VFRAfzPB reer¢Irarc unamrn.
<br />. ..I
<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 CON'I RACT OR OTHER DOCUMENT WITH RESPECT
<br />TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.
<br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCI USIONS AND CONDITIONS OF SUCH POLICIES.
<br />LIMITS SHOWN MAY HAVE. BEEN REDUCED BY PAID CLAIMS.
<br />life TYPE OF INSURANCE ADOL 3UenI
<br />POLICY EFF POLICY ExP 1 --
<br />POLICY NUMBER MM DDrcl' MMlDDrYYYY LIMITS
<br />'
<br />COMMERCIAL GENERAL LIAHfL.ITY
<br />I
<br />3AA414169 )De/>_2/2o2 o�oR/>•B/aoal
<br />EACNOCCURRcNCE
<br />GE Y6WENPED —
<br />DAMA(+REMISn�
<br />$
<br />1,000,000
<br />CLAIMS MADE �] OCCUR
<br />¢rr pGtullBDCOj
<br />g
<br />100, 000
<br />PRIMARY NON-CONTRIBUTORY
<br />MED(:%P.(gnyaneperson)
<br />3
<br />$,000
<br />A
<br />_
<br />X
<br />X
<br />PERSONA'UADVINJURY
<br />S
<br />11000,000
<br />GEIN`_
<br />AGGREGATE LMFT APPI IFS PER:
<br />PRO
<br />PRO-
<br />GENEHA,. AC REGATE
<br />5
<br />2,000,000
<br />1I
<br />POLICY IOC
<br />I
<br />S PROO,IC COMNOP LGG
<br />S
<br />INCLUDED
<br />OCHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />/
<br />6838202C15-75 19/15/T.02D 9/15/2021
<br />COMDIN �(N2,.1 F II IMIT
<br />(Eadwtlan9 a
<br />2r 000, 000o
<br />ANY AUTO
<br />HODLY INJURY IF pero.,) 8
<br />1, 000, 000
<br />B
<br />A-L OVMbC „CHEDULF.O
<br />8 ]C
<br />AJTOS AUTOS
<br />BODILY INJURY PPr A,.PWnt 5
<br />[ 1
<br />11 0001 000
<br />IRFDAUIOS 'NON-0WNED
<br />AUTOS
<br />PROPER(
<br />PROPnge/DAMAGE g
<br />1,000, 000
<br />._ ._'..
<br />rtj
<br />AGGREGATE S
<br />1,600,000
<br />1�
<br />UMBRELLA LIAR OCCUR
<br />l
<br />XL 1578400C 05/02 /302003(D"1./20i1
<br />EACI+OCCJHRENCE 5
<br />5,000, 000
<br />(`
<br />E%C[SS LIAR I CCAIMSMADE
<br />DEC _ T RETENTIONS
<br />ACCRECA'E Y
<br />5,000,000
<br />IPRODUCTS
<br />CON/OP AG F
<br />1, 000 OOO
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'UAeIUTY YIN
<br />WSA 5037498 03 0e/12/2020 09/13/2021
<br />{yTHTUTE -R.r
<br />D
<br />ANY PROPRIETOkrPAR 7 NF.R'FxECLTNc
<br />OFFICERIMEMBER EXCLUUED7 Y
<br />NIA g
<br />FI EACH ACCIDENT'
<br />_.
<br />g
<br />1,000,000
<br />W0.W(OryN NH) ryes. Bi0E NltlVr
<br />ryes.
<br />'..
<br />FL DISLA�, LA LMPIOYEE
<br />--I _..
<br />8
<br />1,000,000
<br />_.
<br />DESCRIPTION OF OPERATIONS PAIax
<br />E.L. DISEASE-POLICYLIMIT
<br />5
<br />1,000,000
<br />E CRIME �105620659
<br />I
<br />OS/24/2020105/24/2021
<br />THIRD PARTY
<br />$1,000,000
<br />DESCRIPTION OF OPERATONS I LOCATIONS / VEHICLES (ACORD
<br />101. Addklonbl RemarkS Scnedula, may On attached It mom spaea Is Moulmd)
<br />City of Santa Ana, Risk Management,
<br />it's officers, employees, agents, representatives, and volunteers
<br />as additional inured.
<br />Certificate of Insurance shall provide thirty (301 day prior written notice of cancellation
<br />CITY OF SANTA ANA RISK MANAGEMENT DIVISION
<br />20 CIVIC CENTER PLAZA, 47H FLOOR
<br />SANTA ANA
<br />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 />1Y� (2 /
<br />CitV Cou
<br />ACORD Z5 (2014101)
<br />— fa 1988-2014 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />reserved.
<br />
|