|
Digitally signed by Tori Pierson
<br />Tori Pierson Date: 2021.10.2709:06:42
<br />-07'00'
<br />'`` o CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />10/20/2021
<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 BELOW.
<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 policy(ies) must have ADDITIONAL INSURED provisions
<br />or be endorsed. If
<br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement.
<br />A statement on this
<br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Aon Risk Insurance Services West, Inc.
<br />Los Angeles CA Office
<br />CONTACT
<br />NAME:
<br />PHONE
<br />(A/CC.No. Ext): (866) 283-7122 A/X No.): (800) 363-0105
<br />E-MAIL
<br />707 Wi 1 shire Boulevard
<br />Suite 2600
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />Los Angeles CA 90017-0460 USA
<br />INSURED
<br />INSURERA: Steadfast Insurance company
<br />26387
<br />ACCO Engineered Systems, Inc.
<br />888 East Walnut Street
<br />Pasadena CA 91101 USA
<br />INSURER B: Liberty Mutual Fire Ins co
<br />23035
<br />INSURERC: LM Insurance corporation
<br />33600
<br />INSURER D: American Fire & casualty co
<br />24066
<br />INSURER E: Berkley Assurance company
<br />39462
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 570089957012 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. Limits shown are as requested
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDNYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />TB2661067353031
<br />10 01 2021
<br />10 01 2022
<br />EACH OCCURRENCE
<br />$2,000,000
<br />CLAIMS -MADE X❑OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$1,000,000
<br />MED EXP (Any one person)
<br />$ 5 , 000
<br />PERSONAL &ADV INJURY
<br />$2,000,000
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />GENERAL AGGREGATE
<br />$4,000,000
<br />POLICY PRO ECT F"LOC
<br />PRODUCTS - COMP/OP AGG
<br />$4,000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE LIABILITY
<br />AS2-661-067353-021
<br />10101120211010112022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$5,000,000
<br />BODILY INJURY( Per person)
<br />X ANYAUTO
<br />BODILY INJURY (Per accident)
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIREDAUTOS NON -OWNED
<br />PROPERTY DAMAGE
<br />ONLY AUTOS ONLY
<br />Per accident
<br />D
<br />EUA2263708502
<br />10/01/2021
<br />10/01/2022
<br />$1,000,000
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />0
<br />$1, 000, 000
<br />DED I RETENTION
<br />C
<br />WORKERS COMPENSATION AND
<br />Y
<br />WA566DO67353011
<br />10/01/2021
<br />10/01/2022
<br />X I PER STATUTE I OTH
<br />-
<br />EMPLOYERS' LIABILITY V/N
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />ANY PROPRIETOR / PARTNER /EXECUTIVE
<br />N
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N/A
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />D ESCdescribe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />E
<br />Env contr Prof
<br />10/01/2021
<br />10/01/2022Aggregate/Each
<br />Loss
<br />$2,000,000
<br />=PCAE)B50155281021
<br />ms Made
<br />Prof Agg SIR
<br />$600,000
<br />applies per policy ter
<br />s & condi
<br />ions
<br />Prof Each claim SIR
<br />$200,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />[RE: Service, city of Santa Ana, 20 civic center Plaza, Santa Ana, CA.]
<br />[AI: The city of Santa Ana, its officers, employees, agents and representatives] are included as Additional Insured with
<br />respect to the General Liability Policy; granted a Waiver of Subrogation for Workers' compensation Policy; and the General
<br />Liability Policy evidenced herein is Primary and Non-contributory to other insurance available as required by written contract
<br />but limited to the operations of the Insured under said contract.
<br />`w
<br />7.
<br />O
<br />Z
<br />W
<br />U
<br />'E
<br />W
<br />U
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />_
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
<br />POLICY PROVISIONS.
<br />IN ACCORDANCE
<br />WITH THE
<br />city of Santa Ana
<br />AUTHORIZED REPRESENTATIVE
<br />Risk Management Division
<br />20 civic center Plaza
<br />Santa Ana CA 92702 USA
<br />n �sd[ctecne� 6trui
<br />R&Aemm & APPRcovED Sv:
<br />©1988-2015ACORD CORPOF
<br />Y3isl,NrnnagernentCteri-1Aicte
<br />ACORD 25 (2016/03)
<br />The ACORD name and logo are registered marks ofACORD
<br />
|