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Digitally signed by Francine R. <br />Francine R. Villareal' Villareal <br />bate: 2021,06.14 16:53:24-07'00' <br />�4 C41111111 Kill, <br />�...�- CERTIFICATE OF LIABILITY INSURANCE <br />DA06110120211 <br />THIS CERTIFICATEISISSUEDASA MATTEROF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THECERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELYOR NEGATIVELY <br />AMEND, EXTEND ORALTERTHECOVERAGEAFFORDED BYTHE POLICIESBELOW.THIS CERTI FICATE OF INSURANCE DOES NOT CONSTITUTE ACONTRACT BETWEEN THE ISSUING INSURERS), <br />AUTHORIZED REPRESENTATIVE OR PRODUCER, ANDTHECERTIFICATE HOLDER - <br />IMPORTANT; If the certificate holder hen ADDITIONAL INSURED, the poliCy(les) must have ADDITIONALINSURED provisions or be endorsed. USUBROGATION 15 WAIVED aubloctto theturna and <br />:Conditions of the policy, Certain policies may require an endorsement, AStatement on this certificate does not Confer rights to thecertifiCate holder in lieu of such endorsomont(sJ. <br />PRODUCER <br />CONTACT <br />NAME: Chuck Hyneman <br />Chuck Hyneman <br />1 B371-A Lemon Drive. <br />PHONE <br />(A/C, NO, EXT): 714-777-9823 <br />FAX <br />(A/C, No): 714-777-9898 <br />Yorba Linda,. CA 92886 <br />EMAIL <br />ADDRESS: <br />INBURER(S)AFFORDING COVERAGE <br />NAIC# <br />INSURED <br />INSURERA:. United States Liability. Insurance Company <br />$eCODd Chance Orange County <br />290 N Paularino Avenue <br />INSURERB: Slate. Compensation Insurance Fund <br />I NSURER O: <br />—.——______.._._..._..._..___.___— — - _._._..__--__.__._. <br />Costa Mesa, CA 92628 <br />INSURER D: <br />INSURERE! <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER:.. REVISION NUMBER: <br />THIS ISTOCERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVEBEEN ISSUED T07HEINSURED NAMEABOVE FORTHE POUC.YPERIOD INDICATED NOTWITHSTANDING ANY <br />REOUIREMEN C TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BEI5SUEDOR MAY PERTAIN,THE INSURANCE AFFORDED BY THE <br />POUCIES DESCRIBED HEREIN IS SUBJECTTOALLTHE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS. <br />INSR <br />ITT <br />TYPE OFINSURANCI; <br />ADDTL <br />INSD <br />SUER <br />VIVO <br />R <br />POLICYry UMBER <br />POLICYEFP <br />(MM/DD)YYYV) <br />POLICY EXP <br />(MMlDAMYYY) <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADEOCCUR <br />—� <br />EACH OCCURRENCE <br />$ 1,000,00 <br />DAMAGETORENTEDPREMISES(Ea OCCUuOhtd) <br />S IUO,OD <br />MED ESP (Anyonepvson) <br />S 6,00 <br />PERSONAL& ADV INJURY <br />3 1,000,00 <br />A <br />Y <br />NPP1578341C <br />09/14/2020 <br />09/14/2021 <br />GENT AGGREGATE LIMA TAPPUES PER: <br />X POLICY ❑ PROJECT ❑ LOC <br />GENERALAGGREGATE <br />3 2,000,00 <br />PRODUC15-CQMP/OPAeC <br />S IncludO <br />s <br />OTHER: <br />AUTOMOBILELIABILITY <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />S 1,000,00 <br />ANYAUTO <br />BODILY INJURY (Per person). <br />$ <br />A <br />OWNEDAUTOS SCHEDULED <br />ONLY AUTOS <br />NPP1578341C <br />Q9114/2020 <br />09/74/202T <br />BODILY INJURY (Per accidapt) <br />§ <br />PROPERTY DAMAGE <br />(Peraccident) <br />S <br />XHIREDAUTOS X NON-DWNED <br />ONLY AUTOSONI-Y <br />- <br />UMBRELLALIAB <br />—_ <br />'OCCUR <br />EACLI OCCURRENCE <br />$ <br />AGGREGATE <br />........ _..... . <br />$ <br />EXCESS UAB <br />CLAIMS -MADE <br />DED RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS'UARILITY <br />PER <br />STATUTE <br />OTI IER. <br />$ <br />6 <br />ANY PROPRIETOR/PARINER/ Y/N <br />EXECURVE OFFICER/MEMBER <br />EXCLUDEM(Mandatoryin NH) <br />N/A <br />9226837 <br />03/01/2021 <br />03/01/2022 <br />EL EACH ACCIDENT <br />S 1,ODO,00 <br />EL DISEASE -EA EMPLOYEE 1,OOD,DO <br />Ifyes,. describe under DESCRIPI ION OF <br />OPERATIONS below <br />E.L. DISEASE - POLIGy LIMIT <br />S 1,000,00 <br />A <br />Professional E & 0 Liability <br />EPLI <br />NPP1578341C <br />09114/2020 <br />09/14/2021 <br />$1;000,000-Each Inc. <br />$2,000,000-Agg <br />$1,000,000 <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if momspace is required) <br />Agreement NUM: A-2020-066-05 <br />Auto Insurance -There Is no owned vehicle 30-Day prior written notice of cancellation <br />City. of Santa Ana, officers, agents,employees and volunteers are named as additional insured on the general liability policy pursuant to written contract, <br />agreement or memorandum of understanding. Such insurance as Is afforded by this policy should he primary and any insurance Carried by the City shall he <br />axr_ess,and nnn datTihintrin, <br />CERTIFICATE HOLDER CANCELLATION <br />Risk Management Division <br />20 Civic Center Plaza <br />ACORD25(2016/03) <br />31-1769 11-15 <br />©1988-2015ACOR <br />a.,go RidrManagsmmEDivis[on <br />z° REVIEWED&APPROVEDBY: <br />sHIM I <br />F44 a Z UCfGc4u! <br />Risk Management Analyst <br />The ACORD nam a and log D are registered marks of ACORD <br />