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ACORO® by Angie DATE(MM/DDIYYYY)
<br />CERTIFICATE OF LIABILITY INSUP tI 1
<br />`� 12/21/2021
<br />_Acevedo
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO geek4e (DFMf—.M—WICM12HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVEF_AGE14FfiS)JWF
<br />A,W 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 endorsements .
<br />PRODUCER
<br />Intel -West Insurance Services (TESCO-1)
<br />License #OB01094
<br />3636 American River Dr, 2nd Floor
<br />CONTACT
<br />NAME: Linda Jordan
<br />PHONE EXII. 916-609-8429 ac Ne:916-979-7992
<br />IAJC. No.E-MAIL
<br />ADOREss: I'ordan iwins.com
<br />Sacramento CA95864
<br />INSURERSAFFORDING COVERAGE
<br />NAICIf
<br />INSURER A: Nall Union Fire Ins Co of Pitt
<br />19445
<br />Licensely OB01094
<br />INSURED
<br />Tri max, a Tesco Controls Company
<br />P.O. Box 299007
<br />INSURER B: Travelers Prop Cas CD of Amer
<br />25674
<br />INSURER C: Everest National Insurance Co.
<br />10120
<br />INSURER D: Navigators Insurance Co.
<br />42307
<br />Sacramento CA 95829
<br />INSURER E :
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 1385923520 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 />SUER
<br />MD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDDIYYYYI
<br />POLICY EXP
<br />fMMMD Y
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />GL5180180
<br />3/1/2021
<br />3/1/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE OCCUR
<br />PREMI ES( RENTED
<br />PREMISES K occurrence)
<br />000.000
<br />MEG EXP (Any one person)
<br />$ 25,000
<br />PERSONAL& ADV INJURY
<br />$1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GEN'L
<br />POLICY l� X I JECT 11 LOG
<br />PRODUCTS - COMP/OP AGG
<br />$2,000,000
<br />Em to ee Benefits
<br />$ 1,000,000
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />CFl CA00150211
<br />3/1/2021
<br />3/1/2022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />IANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident)
<br />$
<br />e
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />Y
<br />Y
<br />ZUP14P6425621NF
<br />3/1/2021
<br />3/1/2022
<br />EACH OCCURRENCE
<br />$5,000.000
<br />AGGREGATE
<br />$ 5,000.000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DEO I X RETENTION$ innurin
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />Y
<br />WC080756394
<br />3/1/2021
<br />3/l/2022
<br />X PERTUTE ER
<br />STA
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />ANYPROPRIETORIPARTNERIEXEGUTIVE M
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatary in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />D
<br />Professional Liab
<br />Y
<br />Y
<br />CH21MPLX00014NC
<br />9/30/2021
<br />9/30/2022
<br />Armn Jate
<br />5,000,000
<br />Rome Date 1112612013
<br />Each Claim
<br />Self -Ins Retention
<br />5,000,000
<br />5li
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD lei, Additional Remarks Schedule, may be attached if more space is required)
<br />General Liability additional insured, primary wording, per project aggregate and waiver of subrogation status applies to requested entities if required by written
<br />contract per the attached endorsements. Auto additional insured, primary wording, and waiver of subrogation status applies to requested entities if required by
<br />written contract per the attached endorsements. Workers Compensation waiver of subrogation status applies to requested entities if required by written contract
<br />per the attached endorsement. 30 day notices applies to requested entities if required by written contract per the attached endorsements. Excess/Umbrella is a
<br />follow form from primary coverage's policy.
<br />The City of Santa Ana, its officers, officials, employees, agents, volunteers and representatives.
<br />City of Santa Ana
<br />Risk Management Division, 4th Floor
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702
<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 />t ' "C�«
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />Risk Management DiWeian
<br />REVevvEDSAPParnvm BY:
<br />A,•yCr Ac v44
<br />® Risk Management SpeOaiist
<br />
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