|
Ugaally signed by F,andneI
<br />Francine R. Villareal Vlllmeal
<br />dale2021 m.Iz 10:43 ss 071
<br />FAMIFOR-01
<br />RTON
<br />OATO/YYYv)
<br />6/30/230/2021
<br />,4�RO CERTIFICATE OF LIABILITY INSURANCE
<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 Llceri OM10410
<br />ArmstronglRobitaillelRiegle Business and Insurance Solutions
<br />830 Roosevelt, Suite 200
<br />Irvine, CA 92620
<br />N JACT
<br />A/� No, E#): (949) 381-7700 a/c, No: 949 487-6151
<br />( )
<br />TAIL . arrinfo@aleragroup.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC 0
<br />INSURER A: Philadelphia Indemnity Ins Co
<br />18058
<br />INSURED
<br />INSURER a:COm West Insurance Company
<br />12177
<br />INSURER C:
<br />Families Forward
<br />INSURER D :
<br />8 Thomas
<br />Irvine, CA 92618
<br />INSURER E
<br />INSURER F :
<br />TSOVERAGFA CFRTIFICATF NIIMRFR• RP1115 M N 111111 aR•
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FORTHE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOROTHER DOCUMENTWITH 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 />ADDLSUBR INSD
<br />MID
<br />POLICY NUMBER
<br />POLICYEFF
<br />POLIIdi pV EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />PHPK2293752
<br />7/1/2021
<br />71112022
<br />EACH OCCURRENCE
<br />it 1,000,000
<br />DAMAGETORENTED
<br />$ 700,000
<br />MED EXP (Any one arson
<br />$ 20,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLI ES PER:
<br />POLICY❑ JELPT LOG
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />GEN'L
<br />PRODUCTS - COMP/OP AGG
<br />$ 3,000,000
<br />SEXUAL ABUSE
<br />1,000,000
<br />OTHER,
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY Per arson
<br />$
<br />X
<br />ANY AUTO
<br />OWNED i SCHEDULED
<br />AUTOS ONLY AUpTNOSSW
<br />PHPK2293752
<br />71112021
<br />7/112022
<br />BODILY INJURY Per accident
<br />$
<br />X
<br />Pelaal Z AMAGE
<br />$
<br />Eo
<br />AUR 08 ONLY X AUTOS ONNLY
<br />A
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EACHOCCURRENCE
<br />$ 4,000,000
<br />X
<br />AGGREGATE
<br />$ 4,0130,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />PHUB774554
<br />7/1/2021
<br />7/112022
<br />DIED X RETENTION$ 10,000
<br />B
<br />AND EMPLOYERS' LIABILIITV
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />(FFILEWMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS I icw
<br />NIA
<br />WCV550516100
<br />7/1/2021
<br />71112022
<br />X STATUTE O1RH
<br />E.L. EACH ACCIDENT
<br />1,ppp,ppg
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE- POLICY LI MIT
<br />1,000,000
<br />A
<br />Professional (E&O)
<br />PHPK2293752
<br />7/1/2021
<br />7/112022
<br />Occurrence
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS f LOCATIONS /VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached If more space Is required)
<br />The City of Santa Ana, Its officers, employees, agents, and representatives are named as Additional Insured on Primary and Non-Contribory basis with
<br />respect to General Liability coverage per attached forms as required in a written contract, agreement, or memorandum of understanding.
<br />30 Days Cancellation Notice unless 10 Days for Non -Payment.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cityof Santa Ana
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL
<br />BE DELIVERED IN
<br />Risk Management Division
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />Rialt iltaNP3Y111aiYtDMalert
<br />L4" i
<br />�ji
<br />REVIEWED&APPROVED BY.
<br />ACORD 25 (2016/03)
<br />91988.2015 ACORD C
<br />The ACORD name and logo are registered marks of ACORD
<br />_
<br />Risk mamyement Analyst
<br />
|