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Francine R. Digitally signed by Francine
<br />R. Villareal
<br />Ru_.-__, namnnn nl Ja n. n.m
<br />ACOR ' CERTIFICATE OF LIABILITY INSURANCE V II Ia I rai
<br />D#YEb(k,MIDDIYYYY)
<br />,2/2212021
<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 />PRODUCER
<br />CONTACT Claribel Garcia
<br />NAME:
<br />Tolman & Wker Insurance Services, LLC
<br />PHONE (805) 585-6179 FAX (805) 585-6179
<br />LA No Ext . A/C No :
<br />196 S. Fir Street
<br />AD L CO arcla tolmanandwikm ecco
<br />ADDRESS: g
<br />PO BOX 1388
<br />INSURERISI AFFORDING COVERAGE
<br />NAIC N
<br />Ventura CA 93002-1388
<br />INSURERA: Crum& Forster Specialty Ins. Co.
<br />44520
<br />INSURED
<br />INSURER B: West American Ins Co
<br />44393
<br />INSURER C: StarNet Ins Co
<br />40045
<br />Instrument Control Services, DBA: ICS
<br />INSURER D
<br />6085 King Drive #100
<br />INSURER E:
<br />Ventura CA 93003
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 21/22 GUAU/XSANC/ED 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 RESPECT TO 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />MD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MIUDDnEori
<br />POLICY
<br />MMIDDIYYYY
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 7X OCCUR
<br />EACH OCCURRENCE
<br />s 1,000,000
<br />DAMA T RENTED
<br />PREMISES R occurrence)
<br />S 50,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL B ADV INJURY
<br />5 1,000 000
<br />A
<br />Y
<br />Y
<br />EPK-137097
<br />09/23/2021
<br />09/23/2022
<br />GEN'LAGGREGATE LIMIT APPLIES PER
<br />POLICY JET LOG
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMPIOPAGG
<br />S 21000,000
<br />$
<br />OTHER.
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />E...cadent
<br />S 1,000,000
<br />x
<br />BODILY INJURY( Per person)
<br />$
<br />ANVAUTO
<br />B
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BAW(22)57612929
<br />10/20/2021
<br />10/20/2022
<br />BODILY INJURY (Per accident)
<br />S
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />UMBRELLA LIAB
<br />�/
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5.000,000
<br />AGGREGATE
<br />S 5,000,000
<br />A
<br />EXCESS ICLAIMS-MADE
<br />EFX-118920
<br />09/2W2021
<br />09/23/2022
<br />DED RETENTION S
<br />S
<br />WORKERS COMPENSATION
<br />PER I 01
<br />C
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERiEXECUTIVE ❑NIA
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />Uses describe under
<br />DESCRIPTION OF OPERATIONS belay
<br />KEY0138780
<br />OS/01/2021
<br />OS/01l2022
<br />STATUTE ER
<br />1
<br />EL EACH ACCIDENT
<br />S 1,000,000
<br />EL. DISEASE -EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE -POLICY UNIT
<br />5 1,Oo0,000
<br />ERRORS & OMISSIONS
<br />A
<br />EPK-137097
<br />09/23/2021
<br />09/23/2022
<br />Limit
<br />1,non Tom
<br />Deductible:
<br />10,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />GL The City of Santa Ana, its officers, officials, employees, and volunteers are Additional Insured as respects to referenced project performs EN01110211
<br />and EN03200211. This Insurance is Primary & Non -Contributory to any other Insurance perform EN01180211. A Waiver of Subrogation is added in favor of
<br />the Additional Insured perform EN1180211. Endorsements apply only as required by current written contract on Ale.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92703 y=+y,,, RfdrhtarugemrnbD"nteton
<br />y%,, REVIEwEn&APpRov®Rr.
<br />©1988.2015 ACOR `• F'A>:-arrsa �, �:.te<e
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD�Risk Management Analyst
<br />
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