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Tori Pierson oa; 2021.111211r,6: °.oaQo.
<br />ACORO® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDD/1YYY)
<br />10/25/2021
<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 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 Erica Homada
<br />NAME: y
<br />The Empire Company
<br />PHONE FAX
<br />FA
<br />Ext: No
<br />550 North Park Center Drive
<br />nooa4ss: ehornaday@empire-co.com
<br />Suite 205
<br />INSURER(S)AFFORDING COVERAGE
<br />NAIC#
<br />Santa Ana CA 92705
<br />INSURERA: Sentinel Insurance Company, LTD
<br />11000
<br />INSURED
<br />INSURER B: Trumbull Insurance Company
<br />27120
<br />RSG, Inc.
<br />INSURERC: Argonaut Insurance Company
<br />19801
<br />17872 Gillette Ave., Suite 350
<br />INSURER D:
<br />INSURER E
<br />Irvine CA 92614
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 2122 2nd Updt 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 CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
<br />CERTIFICATE MAYBE 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 />INSft
<br />LTR
<br />TYPE OF INSURANCE
<br />ADOL
<br />INSD
<br />SUBR
<br />MO
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD
<br />POLICY MIR
<br />MM/DD
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 19 OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PREMISES Ea occunence
<br />$ 1,000,000
<br />MEDEXP(Any one Person)
<br />$ 10,000
<br />PERSONAL aADV INJURY
<br />$ 1,000,000
<br />A
<br />72SBAAQ7019
<br />01/01/2021
<br />01/01/'2022
<br />GEN'LAGGREGATE UMfTAPPUES PER:
<br />X POLICY ElJECT ❑ LOC
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMPIOPAGG$
<br />2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLELIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Par person)
<br />$
<br />ANYAUTO
<br />A
<br />OWNED SCHEOULED
<br />AUTOS ONLY AUTOS
<br />72SBAA07019
<br />01/01/2021
<br />01/01/2022
<br />BODILY INJURY Per eccitlent
<br />( )
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />72SBAAQ7019
<br />01/01/2021
<br />01/01/2022
<br />AGGREGATE
<br />$ 2,000,000
<br />DEO
<br />I X1 RETENTION $ 10.000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED9
<br />IMandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />72WECVK8727
<br />01/01l2021
<br />01/01/2022
<br />PER OTH-
<br />X BTATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE -POUCV LIMIT
<br />$ 1,000,000
<br />Errors & Omissions
<br />LIMIT
<br />2,000,000
<br />C
<br />Claims Made
<br />121MPL0187514-01
<br />03/01/2021
<br />03/01/2022
<br />DEDUCTIBLE
<br />10,000
<br />DESCM"ON OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />RE: RFO No. 21-107 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 4171 1219) and (SS 00 08 04 05). Completed
<br />Operations additional insured applies per form (SS 41 71 1219). General Liability is Primary and Non -Contributory per farm (SS 00 OB 04 05). Auto liabiity
<br />additional insured per form SSO4380909 attached. General Liability and Worker's Compensation Waiver of Subrogation performs (SS 00 08 04 05) and (WC
<br />04 03 06).
<br />City of Santa Ana Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana
<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 />CA 92702 I
<br />'^,V<. RiskManBmrnt IXWan tl
<br />©1988-2015 ACORD COR
<br />The ACORD name and logo are registered marks of ACORD lore Pmwa,r
<br />Ruk hLv,aRemnn Umral Ntle
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