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° CERTIFICATE OF LIABILITY INSURANCE DATE(M DD"YYY) <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 the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer ri hts toto the certificate holder in lieu of such endorsements . <br />PRODUCER <br />CONTACT Paychex Insurance Agency Inc <br />PAYCHEX INSURANCE AGENCY, INC. <br />150 SAWGRASS DRIVE <br />PHONE FAX <br />. 877-266-6850 • ,885-389-7426 <br />E-MAIL Certs@paychex.com <br />ROCHESTER, NY 14620 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURED <br />INSURERA: Sequoia Insurance Company <br />22985 <br />INSURER B: <br />PROUDCITY INC <br />750 GRAND AVE, APARTMENT 3G <br />BROOKLYN, NY 11211 <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMEDABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OFANYCONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCEAFFORDED BYTHE 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 />INSR <br />SUBR <br />VD I <br />POLICY NUMBER <br />POLICY EFF <br />MM/DDf ") <br />POLICY EXP <br />(MMIDDIYYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br />COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />$ <br />CLAIMS-MADEODCCUR <br />$ <br />MOD EXP(Any one person) <br />PERSONAL&ADV INJURY <br />$ <br />_ <br />GENERALAGGREGATE <br />$ <br />GEN•LAGGREGATE LIMIT APPLIES PER: <br />POLICY = PROJECT= LOC <br />PRODUCTS - COMP/OPAGG <br />$ <br />$ <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />ANYAUTO <br />AOWNED <br />AUU TOSSAUTOSSCHEDULED <br />AUTOS <br />NOWNEo <br />HIREDAUTos � AUTOONS <br />BODILY INJURY <br />(Per person) <br />$ <br />BODILY INJURY <br />(Per accident) <br />$ <br />PROPERTY DAMAGE <br />(Per accldent) <br />$ <br />UMBRELLA LIAM EAOCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS BAD = CLAIMS MADE <br />$ <br />DED RETENTION$ <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />OWC1139568 <br />01/15/2021 <br />01/15/2022 <br />X WC STATU- <br />E.L. EACH ACCIDENT <br />$ 1,000,000.00 <br />ANY PROPBIETORIPARTNE WEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? _��y(� <br />(Mandatory In NH) L_'� <br />N/A <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000.00 <br />E.L. DISEASE -POLICY LIMIT <br />$ 1,000,000.00 <br />Ifyes,dec,rEs.Mer <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <br />CERTIFICATE HOLDER <br />CANCELLATION <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <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 />Santa Ana, CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016103) <br />,g RLdeMallltuMDhddmc <br />REVIEWEb$iAPPROVm BV: <br />@1988.2016 ACORD COR ) ;' wf <br />The ACORD name and logo are registered marks of ACORD <br />Rtsk Ma nagement superwor <br />