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. Digitally signed by
<br />Francine R
<br />Francine R. Villareal
<br />Villareal Date: 2021.12.0709:56:21
<br />-08'00'
<br />"� �® CERTIFICATE OF LIABILITY INSURANCE
<br />DAT12 6°oz" Y'
<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: It the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If
<br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this
<br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Aon Risk Services Northeast, Inc.
<br />New York NV Office
<br />One Liberty Plaza
<br />165 Broadway, Suite 3201
<br />NeW York NV 10006 USA
<br />CONTACT
<br />NAME:
<br />PHONE (gfi6) 283-]122 FAX No.);
<br />(AIC.No.Exl): AC. No.:
<br />EMAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />INSURED
<br />INSURER A: National Union Fire Ins Co Of Pittsburgh
<br />19445
<br />JPMorgan Chase & Co.
<br />and subsidiary, affiliated, and
<br />INSURER B: AIU Insurance Company
<br />19399
<br />INSURER C:
<br />associated companies therof
<br />480 Washington Blvd, Floor 10
<br />MAIL CODE- NYl-FO14
<br />INSURER D:
<br />INSURER E:
<br />Jersey City NJ 07310-1616 USA
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 570090514371 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. Limits shown are as requested
<br />LTR
<br />TYPE OF INSURANCE
<br />IN3D
<br />WVD
<br />POLICY NUMBER
<br />MNicIWWW1
<br />GUMDDTYGD1LIMITS
<br />A
<br />GENERAL LIABILITY
<br />GLEACH
<br />OCCURRENCE
<br />$2,000,000
<br />JX,,MMERCMI
<br />CLAIMS -MADE OCCUR
<br />PREMISES Ea omunenm
<br />$1,000,000
<br />MED EXP(Anyone person)
<br />EXcluded
<br />nee Contractual Liability
<br />X
<br />I Hpsl Liquor Llabllily Induced
<br />PERSONAL &ADV INJURY
<br />$2,000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑ JEC1 �X LOG
<br />GENERALAGGREGATE
<br />$2,000,000
<br />PRODUCTS-COMPADPAGG$2,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />AL 7030941
<br />All Other states
<br />06/01/2021
<br />06/01/2022
<br />COMBINED SINGLE LIMIT
<br />Ea earldom)$5,
<br />000,000
<br />BODILY INJURY I Per person)
<br />-JURY
<br />X ANYAUTO
<br />SIR applies per policy terns
<br />& condl
<br />ions
<br />A
<br />A
<br />OWNED SCHEDULED
<br />NLY AUTOS
<br />HIREOAUDTOS NON OWNED
<br />ONLY AUTOS ONLY
<br />AL 7030942
<br />MA
<br />AL 7030943
<br />06/01/202106/01/2022
<br />06/01/202106/01/2022
<br />BODILY IN (Par accident)
<br />PROPERTY DAMAGE
<br />Pereccident
<br />VA
<br />A
<br />%
<br />UMBRELLALIA
<br />X
<br />OCCUR
<br />21335683
<br />06 01/2021
<br />Ofi O1/Z022
<br />EACH OCCURRENCE
<br />$10,000,000
<br />EXCESS LIAB
<br />CLAIMS MADE
<br />AGGREGATE
<br />$10, 000, 000
<br />OEO X
<br />RETENTKIN 410, coo
<br />B
<br />WORKERS COMPENSATIONAND
<br />EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR I PARTNER I EXECUTIVE
<br />OFFICEReMEMBEH EXCLUDED? I
<br />NIA
<br />w:16393211
<br />All other States
<br />SIR applies per policy terns
<br />06/01/2021
<br />& condi
<br />O6 01 2022
<br />ions
<br />X PERSTATUTE OTH-
<br />E
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE EA EMPLOYEE
<br />$1.000,000
<br />e
<br />(Mandatary In NH)
<br />Il yes, describe antler
<br />DE SCRIPTIONOFOPEHATIONSbelow
<br />WC16393210
<br />MN
<br />06/01/2021
<br />06/01/2022
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,006
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is requited)
<br />City of Santa Ana, its officers, officials, employees, and volunteers are included as Additional Insured in accordance with the
<br />policy provisions of the General Liability policy. General Liability policy evidenced herein is Primary and Non -Contributory
<br />to other insurance available to Additional Insured, but only in accordance with the policy's provisions. A waiver of
<br />Subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the General Liability,
<br />Automobile Liability and Workers' Compensation policies.
<br />CERTIFICATE HOLDER CANCELLATION 0
<br />city of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702 USA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />01988-2015 ACORD CO
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />����%,,�/� ���
<br />:yil11-111i'r4
<br />Risk Mnugmnent Division
<br />REVIEV7ED & APPROVED BY:
<br />®-'
<br />Risk Management Analyst
<br />
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