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ogi,enysgnea Mv,a�aneRmuamai <br />Francine R. Villareal_ <br />ACORD CERTIFICATE OF LIABILITY INSURANCE DAT07/0612021 NYYY) DD <br />TM. <br />PRODUCER Phone: 562-943-7174 Fax: 562-947-7957 <br />BLAKE P. SANBORN INSURANCE <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />16264 WHITTIER BLVD. <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />WHITTIER CA 90603 <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />NAIL # <br />Apancy Lick 0072770 <br />INSURED <br />INSURERA: HARTFORD INSURANCE COMPANY <br />PACIFIC COLLEGE, INC. <br />INSURER B: EMPLOYERS INSURANCE COMPANY <br />3160 RED HILL AVE. <br />COSTA MESA CA 92626 <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />GOVEHAUES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />ASOL <br />INSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICYEFFECTNE <br />DATE MMIDO <br />PODCYEX%RATION <br />DATE MWOD <br />LIMITS <br />GENERAL <br />LIABILITY <br />57SBABN5877 <br />06/01121 <br />06/01/22 <br />EACH OCCURRENCE <br />$ 2,000,066 <br />X <br />DAMAGE TO RENTED <br />PBEMISES(Ea am rPn <br />$ 100,000 <br />COMMERCIALGENERALLIABIUTY <br />CLAIMS MADE OCCUR <br />MED. EXP(Any one person) <br />$ 5,000 <br />PERSONAL&ADV INJURY <br />$ 2,000,000 <br />A <br />YES <br />GENERAL AGGREGATE <br />$ 4,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRO - <br />POLICY JECT LOG <br />PRODUCTS-COMP/OPAGG. <br />$ 4,000,000 <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />ANY AUTO <br />(Ea accident) <br />$ <br />ALL OWNED AUTOS <br />BODILY INJURY <br />SCHEDULEDAUTOS <br />(Per person) <br />$ <br />HIRED AUTOS <br />NON-OWNEDAUTOS <br />BODILY INJURY <br />(Pe'.coldont) <br />$ <br />PROPERTY DAMAGE <br />(Per acc dent) <br />$ <br />GARAGE LIABILITY <br />AUTO ONLY -EAACCIDENT <br />$ <br />OTHERTHAN EAACC <br />$ <br />ANYAUTO <br />AUTOONLY: ADS <br />$ <br />EXCES9l UMBRELLA LIABILITY <br />EACH OCCURRENCE <br />$ <br />OCCUR CLAIMS MADE <br />AGGREGATE <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />$ <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />EIG2104339 07 <br />05126/21 <br />05/26/22 <br />WC <br />TOW LIMITS OTHER <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />B <br />ANY PROPRIETOWPARTNEWEXECUTIVE <br />OFFICEWMEMSER EXCLUDED? <br />Ifya,,a%odbnenncr <br />E.L. DISEASE -EA EMPLOYEE <br />$ 1,000,000 <br />E.L. DISEASEPOUCY LIMIT <br />$ 1,000,000 <br />SPECIAL PROVISIONS below <br />OTHER: <br />DESCRIPTION OF OPERATIONS/LOCATIONSA7EHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />THE CITY OF SANTA ANA ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS, AND REPRESENTATIVES ARE NAMED AS ADDITIONAL <br />t .INSURED. <br />CITY OF SANTA ANA <br />RISK MANAGEMENT DIVISION, 4TH FLOOR <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CA 92702 <br />Attention: <br />ACORD 25 (2001108) Certificate # 30107 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL 80 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. <br />.PAI n RISIaMmwgtm?a?tDlvisimT <br />REMEWED&APPROVEDBY. " <br />ICskk4a0aUernt;ItLFiRRlySt <br />