|
Tori Pierson o„.m, ,tea o, Page 1 of 2
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />D Y)
<br />oe/1zo21
<br />08/19/202
<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 endorsement(s).
<br />PRODUCER
<br />CONTACT NAME: Willis Towers Watson Certificate Center
<br />Willis Towers Watson Northeast, Inc.
<br />PHONE FA%
<br />c/o 26 Century Blvd
<br />1-877-945-7378 AIC No: 1-888-467-2378
<br />EMAIL certificates@willis. com
<br />ADDRESS:
<br />P.O. Box 305191
<br />INSUREl AFFORDING COVERAGE
<br />NAIC #
<br />Nashville, TN 372305191 USA
<br />INSURER A: Great Northern Insurance Company
<br />20303
<br />INSURED
<br />INSURER B: Federal Insurance Company
<br />20281
<br />Language Line Services, Ina.
<br />INSURER C: vigilant Insurance Company
<br />20397
<br />attn: Celia Franco
<br />INSURER D: Westchester Surplus Lines Insurance Compan
<br />10172
<br />One Lower Ragsdale Drive
<br />Building 2
<br />Monterey, CA 93940
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: W21834649 REVISION NUMBER -
<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 />LTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />INSD
<br />MO
<br />POLICYNUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICYEXP
<br />MMIDDIYYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL L[ABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CI -AIMS -MADE � OCCUR
<br />DAMAGE TED
<br />PREMISESS(Ea rre occunce
<br />$ 1,000,000
<br />MED EXP(Anyone pemon)
<br />$ 10,000
<br />A
<br />y
<br />3595-61-78
<br />06/01/2021
<br />06/01/2022
<br />PERSONAL 4 ADV INJURY
<br />$ 1,000,000
<br />LIMIT APPLIES PER:
<br />POLICY PECiRO- ❑ LOC
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />GEN'LAGGREGATE
<br />X
<br />PRODUCTS - COMP/OP AGO
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILEUABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea acddenl
<br />$ 1,000,000
<br />BODILY INJURY (Par Person)
<br />$
<br />ANY AUTO
<br />B
<br />X
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />(21) - 7357-61-09
<br />06/01/2021
<br />06/01/2022
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />B
<br />X
<br />UMBRELLALIAB
<br />I X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />7987-71-21
<br />06/01/2021
<br />06/01/2022
<br />DED RETENTION
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILRY
<br />ANYPROPRIETORIPARTNERIEXECUTIVE Y
<br />OFFICERIMEMBEREXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />(22) 7174-35-69
<br />06/01/2021
<br />06/01/2022
<br />X PER I OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />D
<br />Errors 6 Omissions
<br />G21654711 019
<br />06/01/2021
<br />06/01/2022
<br />Each Claim
<br />$10,000,000
<br />Aggregate
<br />$10,000,000
<br />Retention
<br />$1001000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Professional Liability coverage includes coverage for contingent bodily injury, property damage and wrongful acts such
<br />as the disclosure of confidential information. Coverage is true worldwide.
<br />The City of Santa Ana, its officers, officials, employees, and volunteers are included as Additional Insureds as
<br />respects to General Liability.
<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 />City of Santa Ana
<br />Risk Management Division AUTHORIZED REPRESENTATIVE//■�\ Ryi Mmwgv,rvdgNYm
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702 11YIII I %dsl ;!rcWar
<br />V TNbO-LUTb AGVKU Ia .."....-.."'-.._... ",•.•�••"'•
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />BR ID: 21481517 enrce: 2206919
<br />
|