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Francine R. Digitally signed by
<br />Francine R. Villareal
<br />Villareal Date: 2022.02.24
<br />104s 19-DR'00'
<br />d'is CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIODrIYYY)
<br />ovamzosz
<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 BELOW.
<br />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. 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 />ADD Risk Insurance Services West, Inc.
<br />Los Angeles CA officeINC.
<br />coNT
<br />AME:Acr
<br />PHONE (866) 283-7122 FaX (800) 363-010$
<br />No. Eat): uc. xo.:
<br />707 Wilshire Boulevard
<br />Suite 2600
<br />E+aAIL
<br />ADDRESS:
<br />Los Angeles CA 90017-0460 USA
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC#
<br />INSURED
<br />INSURERA: Zurich American Ins Co
<br />16535
<br />Heed Electric, Inc.
<br />13138 Arctic Circle
<br />Santa Fe Springs CA 90670 USA
<br />INSURER B: RSUI indemnity company
<br />22314
<br />INSURERC: American Guarantee & Liability Ins Cc
<br />26247
<br />INSURERD: Crum & Forster Specialty insurance Co.
<br />44520
<br />INSURER E:
<br />Bee
<br />COVERAGES CFRTIFICATF NIIIII 57ooQ15FARAQ Rcul'Urim MUNsnco.
<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 TERM$
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as re uested
<br />INSR
<br />TYPE OF INSURANCE
<br />ADOL
<br />BUBR
<br />POLICYNUMBER
<br />POLICY EFF
<br />10/01/2021
<br />POLICY UP
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />Y
<br />Y
<br />6L0323075803
<br />10 0 2
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CIAIMS-MADE xI OCCUR
<br />DAMAGE TO RENTEDcurtence
<br />P ESEaoc
<br />$300,000
<br />TXCONIMERCIAL
<br />MED EXP(my one person)
<br />$S,000
<br />PERSONAL& AOV INJURY
<br />$1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE
<br />$2,500,000
<br />POLICY X PRO x Lee
<br />JECT
<br />PRODUCTS-COMPIOP AGG
<br />$2,000, 000
<br />OTHER:
<br />A
<br />AUTOMOBILELIASIUTY
<br />Y
<br />Y
<br />BAP 3230759 - 03
<br />10/01/20211010112022
<br />COMBINED SINGLE LIMIT
<br />g1, 000, 000
<br />BODILY INJURY ( Per person)
<br />AINY AUTO
<br />OWNED SCHEDULED
<br />BODILY INJURY (Per axident)
<br />AUTOS ONLY AUFOS
<br />HINEDAUTOS NON -OWNED
<br />PROPERTY DAMAGE
<br />ONLY AUTOS ONLY
<br />Perarodenl
<br />CompJColl. Ded.
<br />$2 , SOO
<br />G
<br />X
<br />UNKUELLALIAB
<br />X
<br />OCCUR
<br />AUC324371203
<br />10/01/2021
<br />10/01/2022
<br />EACHOCCURRENCE
<br />$S'Lin H.
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$51000,000
<br />OED RETENTION
<br />A
<br />WORMERSCOMPENSATIONAND
<br />Y
<br />wc324371103
<br />10/01/2021
<br />10/01/2022
<br />X
<br />I PER STATUTE
<br />oTH
<br />EMPLOYERS' LIABILITY
<br />El EACH ACCIDENT
<br />$1,000,000
<br />ANY PROPRIETOR I PARTNER I EXECUTIVE
<br />N
<br />OFFICEWMEMBER ERCLUDEDi
<br />NIP
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />(Mandab,y In NH)
<br />DESCRIPTION OF OPERATIONS be.
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />D
<br />Env Contr Poll
<br />PKC112160
<br />10/01/2021
<br />10/01/2022
<br />Each POLL Condition
<br />$2,000,000
<br />Claims made
<br />Deductible
<br />$10,000
<br />Aggregate Limit
<br />$3,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached Nmom space is required)
<br />city of Santa Ana, its officers, employees, volunteers, agents and representatives are included as Additional insured in
<br />accordance with the policy provisions of the General Liability and Automobile Liability policies. General Liability policy
<br />evidenced herein is Primary and Non -Contributory to other insurance available to Additional Insured, but only in accordance
<br />with the policy's provisions. A waiver of subrogation is granted in favor of Certificate Holder in accordance with the policy
<br />provisions of the General Liability, Automobile Liability and Workers' Compensation policies.
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<br />CERTIFICATE HOLDER CANCELLATION eak
<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 />POUCYPROVISIONS.
<br />Cit Of Santa Ana AUTHORQED REPRESENTATIVE
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana CA 92701 USA L�//��''��//{{•��
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<br />©1988-2015 ACORD
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />//REVIEwEC&APPRavi
<br />r��4,"Hisk .! D vj&4 C
<br />Risk Management Analyst
<br />
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