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Francine R. Villareal yN.,aeelisigned nrF,aermaa,
<br />FAMIFO "Date: 3021,07.,E laF55 F7 day
<br />AC "J?"' R-01 R O G
<br />k - CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYVYY)
<br />6/39/2021
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
<br />NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
<br />BELOW.
<br />POLICIES
<br />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
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of
<br />policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />the policy, certain
<br />this certificate does not confer rights to the certificate holder in lieu of such
<br />policies may require an endorsement. A statement on
<br />endorsements
<br />PRODUCER License 9 UM10410
<br />.
<br />NO TACT
<br />ArmstrongfRobitallle/Rlegle Business and Insurance Solutions
<br />PNAAONE
<br />(ac, No, E.t): (949) 381-77DO nlc, No :(949) 487-6151
<br />830 Roosevelt, Suite 200
<br />Irvine, CA 92620
<br />A�AIEs . arrinfo@aleragroup.Com
<br />INSURER 11 AFFORDING COVERAGE
<br />NAIC ft
<br />INSURED
<br />INSURER A: Philadelphia IndemnityIns Co
<br />18058
<br />INSURER B:COm WOSt Insurance Company
<br />12177
<br />Families Forward
<br />INSURER C:
<br />8 Thomas
<br />INSURER D
<br />Irvine, CA 92618
<br />INSURER E :
<br />COVFRAriFC
<br />NSURER F:
<br />THIS
<br />INDICATED.
<br />CERTIFICATE
<br />EXCLUSIONS
<br />JLMMEN
<br />---
<br />IS TO CERTIFY THAT THE POLICIES
<br />NOTWITHSTANDING ANY
<br />MAYBE ISSUED OR MAY
<br />AND CONDITIONS OF SUCH
<br />TYPE OF INSURANCE
<br />OF
<br />REQUIREMENT,
<br />PERTAIN,
<br />POLICIES.
<br />ADDLSUBR
<br />INSURANCE
<br />`aruca.nc
<br />LISTED BELOW HAVE
<br />TERM OR CONDITION OF
<br />THE INSURANCE AFFORDED BY
<br />LIMITS SHOWN MAY HAVE BEEN
<br />POLICY NUMBER
<br />BEEN ISSUED
<br />ANY CONTRACTOR
<br />THE POLICIES
<br />REDUCED BY
<br />POLICY EFF
<br />TO THE INSURED
<br />OTHER
<br />DESCRIBED
<br />PAID CLAIMS.
<br />POLICY EXP
<br />OD
<br />REVISION NUMBER:
<br />NAMED ABOVE FOR
<br />DOCUMENT WITH RESPECT
<br />HEREIN IS SUBJECT
<br />LIMITS
<br />THE POLICY PERIOD
<br />TO WHICH THIS
<br />TO ALL THE TERMS,
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />AMAGECH
<br />$ 1,000,000
<br />CLAIMS MADE X OCCUR
<br />❑
<br />y,
<br />PHPK2293752
<br />7/1/2021
<br />71112022
<br />DAMAGEORENTEDRENCE
<br />TO
<br />PREMISES(E. QTov ce)
<br />$ 100,000
<br />MED EXP (Any oneperson)
<br />20,000
<br />A
<br />PHPK2293752
<br />711/2027
<br />7!1/2022
<br />GEN'L
<br />AUTOMOBILE
<br />X
<br />X
<br />AGGREGATE LIM IT APPLIES PER:
<br />POLICY ❑ PP0 ❑X LOC
<br />OTHER:
<br />LIABILITY
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS p
<br />VMS ONLY X AO1TNpSONEV
<br />PERSONAL &ADV INJURY
<br />1,000,000
<br />GENERAL AGGREGATE
<br />3,000,000
<br />PRODUCTS- COMP/OPAGG
<br />3,000,000
<br />SEXUAL ABUSE
<br />COMBINED SINGLE LIMIT
<br />E accitl t
<br />BODILY INJURY Per erson
<br />1,000,000
<br />1,000,000
<br />$
<br />B0DILYINJURY
<br />JU Y(Peraccident
<br />$
<br />Per accident
<br />$
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />A
<br />X
<br />UMBRELLA LIAB X OCCUR
<br />Excess LIAB CLAIMS -MADE
<br />PHUB774554
<br />7/1/2021
<br />7/1/2022
<br />OED X RETENTION$ 10,000
<br />AGGREGATE
<br />4,000,000
<br />X PER OTH-
<br />ST UTE E
<br />B
<br />A
<br />WORKERS COMPENSATION
<br />ANO EMPLOYERS' LIABILITY
<br />AApNY PRgOqPRIETOER�IPARTNERIEXECUTIVE YIN
<br />(ManEa?o EIDNH) EXCLUDED? ❑
<br />I(yyes, describeunder
<br />DESCRIPTIONO OPERATIONS below
<br />Professional (E&O)
<br />NIA
<br />WCV550516100
<br />PHPK2293752
<br />7/1/2021
<br />71112021
<br />71112022
<br />711/2022
<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 />Occurrence
<br />1,000,000
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS IVE HICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is real b rad)
<br />The City of Santa Ana, Its officers, employees, agents, and representatives are named as Additional Insured on Primary and Non-Contribory basis with
<br />respect to General Liability coverage per attached forms as required in a written contract, agreement, or memorandum of understanding.
<br />30 Days Cancellation Notice unless 10 Days for Non -Payment.
<br />CERTIFICATE Nnl nFR
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<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 />'461m aCA.h
<br />ACORD 25 (2016/03) ©1988-2015 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />_dabsRldcMwtegrnurdDiuielon
<br />8 RE%EIJED&APPRWEDBr
<br />I
<br />RnkMznagement AnafysE
<br />
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