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Francine R. Digitally signed by Francine
<br />Villareal
<br />1 1 0 vmaleal
<br />UatDATEI(MM/DD36
<br />AIll CERTIFICATE OF LIABILITY INSURANCE
<br />/YYY-07
<br />1 5/212021
<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: Melissa M Cisneros
<br />W. B. Adams Co.
<br />A/cNNo Ezt: (503)644-9945 : (503)644-9997
<br />(A C,No
<br />General Insurance
<br />ADDRESS: Commerciallz@wbadams.eom
<br />14737 SW Milliken Way
<br />INSURERS) AFFORDING COVERAGE
<br />NAICq
<br />Beaverton OR 97003
<br />INSURER A: Sentinel Insurance Company
<br />11000
<br />INSURED
<br />INSURER B: Hartford Accident and Indemnity Company
<br />22357
<br />Selectron Technologies, Inc.
<br />INSURER C:
<br />12323 SW 66th Ave
<br />INSURER D:
<br />Portland, OR, 97223
<br />INSURER E:
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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 />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />yWU
<br />POLICY NUMBER
<br />(MMIDD
<br />POLICYtXP
<br />(MMa1DIYYYY)
<br />LIMITS
<br />A
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FxIOCCUR
<br />Ongoing and Completed Ops End
<br />Y
<br />52SBAR09216
<br />01/31/2021
<br />01/31/2022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PREMISES (Ea occurrence)
<br />$ 1,000,000
<br />X
<br />MED EXP (Any one person)
<br />$ 10,000
<br />X
<br />Primary Endorsement
<br />PERSONAL a ADV INJURY
<br />$ 1,000,000
<br />GEN-L AGGREGATE LIMIT APPLIES PER:
<br />POLICY F—]jEOT FILOC
<br />OTHER:
<br />GENERAL -AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />Deductible
<br />$ 1,000
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />52UECPT5600
<br />01/31/2021
<br />01/31/2022
<br />(Ea accident)
<br />$ I,OOD,000
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY addition)
<br />)
<br />$
<br />(Per acceerin
<br />$
<br />Comp/Collision
<br />$ 5001500
<br />A
<br />)C
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />52SBAR09216
<br />01/31/2021
<br />01/31/2022
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />S 5,000,000
<br />DED
<br />X RETENTION$ 10,000
<br />Deductible
<br />$ 1,000
<br />B
<br />WORKERS COMPENSATION
<br />NDEMPLOYERS` LIABILITY YIN
<br />V PROPRIETOR/PARTNER/EXECUTIVE E
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If ye t, doctors under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />52WBCGI3039
<br />01/312021
<br />01/31/2022
<br />-
<br />STATUTE X ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />EL.DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />EL.DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Data Breacll/Cyber Liability
<br />Professional Liability/E&O
<br />52SBAR09216
<br />01/31/2021
<br />01/312022
<br />Each Occurrence
<br />Aggregate
<br />$2,000,000
<br />$2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />The City of Santa Ana, its officers, employees, agents, volunteers and representatives are named Additional Insured as respects to General Liability when required by written
<br />contract.
<br />City of Santa Ana
<br />Risk Management Division, 4th Floor
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<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 />© 1988-2015 ACORD
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />i9
<br />9
<br />Riele Management DtWslon
<br />REVIEWED 6 APPROVED BY:
<br />F44*Yi" ♦R, vjfirn Ls.�
<br />—.
<br />Risk Management Analyst
<br />
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