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<br />DATE (MM/DD/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />06/14/2022
<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 />CONTACT
<br />PRODUCER Erica Hornaday
<br />NAME:
<br />FAX
<br />PHONE
<br />The Empire Company
<br />(A/C, No):
<br />(A/C, No, Ext):
<br />E-MAIL
<br />550 North Park Center Driveehornaday@empire-co.com
<br />ADDRESS:
<br />Suite 205
<br />INSURER(S) AFFORDING COVERAGENAIC #
<br />Santa AnaCA92705Sentinel Insurance Company, LTD11000
<br />INSURER A :
<br />INSURED Trumbull Insurance Company27120
<br />INSURER B :
<br />RSG, Inc.Argonaut Insurance Company19801
<br />INSURER C :
<br />17872 Gillette Ave., Suite 350
<br />INSURER D :
<br />INSURER E :
<br />IrvineCA92614
<br />INSURER F :
<br />2022/2023 2nd Updt Master
<br />COVERAGESCERTIFICATE 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 />ADDLSUBR
<br />INSRPOLICY EFFPOLICY EXP
<br />TYPE OF INSURANCELIMITS
<br />POLICY NUMBER
<br />LTR(MM/DD/YYYY)(MM/DD/YYYY)
<br />INSDWVD
<br />COMMERCIAL GENERAL LIABILITY 1,000,000
<br />EACH OCCURRENCE$
<br />DAMAGE TO RENTED
<br />1,000,000
<br />CLAIMS-MADEOCCUR$
<br />PREMISES (Ea occurrence)
<br />10,000
<br />MED EXP (Any one person)$
<br />AYY72SBAAQ701901/01/202201/01/20231,000,000
<br />PERSONAL & ADV INJURY$
<br />2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$
<br />PRO-
<br />2,000,000
<br />POLICYLOCPRODUCTS - COMP/OP AGG$
<br />JECT
<br />$
<br />OTHER:
<br />COMBINED SINGLE LIMIT
<br />AUTOMOBILE LIABILITY 1,000,000
<br />$
<br />(Ea accident)
<br />ANY AUTOBODILY INJURY (Per person)$
<br />OWNEDSCHEDULED
<br />AY72SBAAQ701901/01/202201/01/2023
<br />BODILY INJURY (Per accident)$
<br />AUTOS ONLYAUTOS
<br />HIREDNON-OWNEDPROPERTY DAMAGE
<br />$
<br />(Per accident)
<br />AUTOS ONLYAUTOS ONLY
<br />$
<br />UMBRELLA LIAB 2,000,000
<br />OCCUREACH OCCURRENCE$
<br />A EXCESS LIAB 72SBAAQ701901/01/202201/01/20232,000,000
<br />CLAIMS-MADEAGGREGATE$
<br />10,000
<br />DEDRETENTION$$
<br />PEROTH-
<br />WORKERS COMPENSATION
<br />STATUTEER
<br />AND EMPLOYERS' LIABILITY
<br />Y / N
<br />1,000,000
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT$
<br />BY N / A Y72WECVK872701/01/202201/01/2023
<br />OFFICER/MEMBER EXCLUDED?
<br />1,000,000
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYEE$
<br />If yes, describe under
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$
<br />AGGREGATE LIMIT$4,000,000
<br />Errors & Omissions
<br />C121MPL0167514-0203/01/202203/01/2023EACH CLAIM$2,000,000
<br />Cliams Made
<br />DEDUCTIBLE$10,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE:Affordable Housing Financial, Analytical And Advisory Services.
<br />City of Santa Ana, its agents, officers, officials, employees, and volunteers are named as additional insured on this policy pursuant to written contract,
<br />agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City shall be
<br />excess and non-contributory under the General Liability, where required by written contract, per form (SS 41 71 12 19) and (SS 00 08 04 05). Completed
<br />Operations additional insured applies per form (SS 41 71 12 19). General Liability is Primary and Non-Contributory per form (SS 00 08 04 05). Auto liabiity
<br />additional insured per form SS04380909 attached. General Liability and Worker's Compensation Waiver of Subrogation per forms (SS 00 08 04 05) and (WC
<br />04 03 06).
<br />CERTIFICATE HOLDERCANCELLATION
<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 />City of Santa Ana Risk Management Division
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa AnaCA92702
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
<br />
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