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Francine R. Digitally signed by Francine R. <br />vvII II II Villareal <br />STAGPLU�1al Date: zoz . 0TERRYHILI <br />,d►coRO CERTIFICATE OF LIABILITY INSURANCE <br />DATE 10/20/2021Y) <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 <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 <br />NAME: <br />PHONE FAX <br />(A/C, No, Ext): (714) 505-5550 (A/C, No):(714) 975-8966 <br />NFP Property & Casualty Services, Inc. <br />1551 North Tustin Avenue <br />Suite 500 <br />Santa Ana, CA 92705 <br />E-MAIL <br />DD RIESS: <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURERA:Ohio Security Insurance Company <br />24082 <br />INSURED <br />INSURER B: American Fire and Casualty Company <br />24066 <br />INSURER 7 <br />Stage Plus, Inc. <br />INSURER D 7 <br />P.O. Box 11060 <br />Santa Ana, CA 92711 <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 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 />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE X OCCUR <br />X <br />X <br />BKS58241997 <br />7/29/2021 <br />7/29/2022 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />500,000 <br />$ <br />MED EXP (Any oneperson) <br />$ 15,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GENT <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />X <br />POLICY PRO LOC <br />PRODUCTS-COMP/OPAGG <br />$ 2,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY Perperson) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY Per accident <br />$ <br />PROPERTY DAMAGE <br />ccident <br />Per accident) <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />B <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 1,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />ESA58241997 <br />10/20/2021 <br />7/29/2022 <br />AGGREGATE <br />$ 1,000,000 <br />X <br />DED RETENTION $ 0 <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />PER OTH- <br />STATUTE ER <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ <br />OFFICER/MEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />N / A <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured in regards to General Liability per attached CG8810 0413 <br />pursuant to written contract, agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance <br />carried by City shall be excess and noncontributory. 30 Days' notice of Cancellation EXCEPT 10 Days' Notice for non-payment of premium. Please note that <br />the CG2037 Completed Ops Endorsement has been ordered from Liberty Mutual Insurance. <br />UMBRELLA POLICY IS FOLLOWING FORM <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana <br />Y <br />THE EXPIRATION DATE THEREOF, <br />NOTICE WILL 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 <br />RisieMallagementDiviaian <br />JI <br />REVIEWED & APPROVED BY.- <br />r <br />a <br />v� <br />ACORD 25 (2016/03) <br />© 1988-2015 ACORD C <br />The ACORD name and logo are registered marks of ACORD <br />Risk Management Analyst <br />