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"quay signed M Fa„smea
<br />Francine R. Villareal Is .... I
<br />TOAND-1 nese i.ntytyiliy -WA
<br />'44c"M CERTIFICATE OF LIABILITY INSURANCE
<br />DATD
<br />o51281lzafz021zl
<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 endorsements .
<br />PRODUCER 858-457-5720
<br />Rubin Insurance Agency Inc.
<br />CA Lic 0645355
<br />N xTeCT Michael Rubin
<br />PHONE 856-457.5720 FAX 858-457-5729
<br />(A/c, xo, Ext : ac, Na
<br />5075 Shoreham Place, Suite 100
<br />San Diego, CA 92122
<br />Michael Rubin
<br />-� ,mic ae ru ininsurance.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: National Interstate Ins Co
<br />32620
<br />INSUREDStandard Enterprises Inc
<br />Dba: To and MID Towing
<br />518 N Poinsettia St
<br />INSURERB: Golden Bear Insurance Co.
<br />39861
<br />INSURER C: Insurance Company of the West
<br />27847
<br />Santa Ana, CA 92701
<br />NSURER D
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER- RPVIAU'llu NI IMRPR.
<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 />TYPE OF INSURANCE
<br />DDL
<br />NSD
<br />SUER
<br />MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPIML
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE �X OCCUR
<br />y
<br />T0000143.02
<br />OW0112021
<br />0610112022
<br />EACH OCCURRENCE
<br />1,000,000
<br />PREMI ETORENTED
<br />100,000
<br />MEDEXP An one arson
<br />5,000
<br />PERSONAL B ADV INJURY
<br />1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑ jE�T LOG
<br />GENERAL AGGREGATE
<br />2,000,000
<br />PRODUCTS COMPIOPAGG
<br />1 2,000,000
<br />Ded
<br />Q
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />1 000 00g
<br />BODILY INJURY Per arson
<br />ANYAUTO
<br />OWNED X SCHEDULED
<br />ALTOS ONLY AUpTOS
<br />y
<br />TWT0000143.02
<br />06/0112021
<br />0610112022
<br />BODILY INJURY Per accident
<br />X
<br />I acre ,lnt AMAGE
<br />pp
<br />AUTS ONLY X AUTO ONLY
<br />X
<br />Union Motor
<br />B
<br />UMBRELLA LAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />5,000,000
<br />M
<br />AGGREGATE
<br />51000,000
<br />X
<br />EXCESS LABCLAIMS-MADE
<br />GBX33002
<br />06/0112021
<br />0610112022
<br />DED I X I RETENTION$ O
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNEWEXECUTNE Y�
<br />FFHCEWMEindationr NH)EXCLUDED?
<br />Ryes describe under
<br />DESCRIPTION OF OPERATIONS below__T
<br />NIA
<br />Y
<br />SD5020840.10
<br />04101I2021
<br />04/0112022
<br />V IPER OTH-
<br />EER
<br />E.L EACH ACCIDENT
<br />1,000,000
<br />E.L DISEASE -EA EMPLOYE
<br />1,DDD,BDD
<br />E.L DISEASE - POLICY LIMIT
<br />1,000,000
<br />A
<br />GKLL
<br />T0000143.02
<br />0610112021
<br />06/01/2022
<br />Ded $500
<br />500,000
<br />A
<br />On-Hook/Cargo
<br />T0000143-02
<br />06101/2021
<br />06/01/2022
<br />Ded $1000
<br />150,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached it more space Is required)
<br />City of Santa Ana, its officers, employees, agents and representatives are
<br />named as additional insured with respects to general and auto liability of
<br />the named insured, pursuant to written contract, agreement or memorandum of
<br />understanding. Coverage is primary and non-contributory. Blanket general
<br />liability additional insured endorsement CG2010(0413) and primary and none
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />ACORD 25 (2016103)
<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 />©1988-2015 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />REVIEWED & APPROVED Sr.
<br />FU4� P'. VJ44 esP
<br />Risk Management Analyst
<br />
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