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Dlgblly signed by F,andne R.
<br />Francine R. Vlllare8}y(la m
<br />oak: 2021.07a2 1CA3S' oral•
<br />FAMIFOR-01 RTONG
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DAT 6/30/2021 V)
<br />30/2021
<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 endorsements .
<br />PRODUCER License# OM10410
<br />Armstrong/Robitaille/Riegle Business and Insurance Solutions
<br />830 Roosevelt, Suite 200
<br />Irvine, CA 92620
<br />CONTA
<br />AMENCT
<br />'AIC
<br />No, Ext: (949) 381.7700 FAX, No :(949) 487-6151
<br />EDORIES,
<br />arrinfo@aleragroup.com
<br />INSURERISI AFFORDING COVERAGE -
<br />NAIC H
<br />INSURER A: Phlladell2hla Indemnity Ins Co
<br />18058
<br />INSURED
<br />INSURER B:Com West Insurance Company
<br />12177
<br />INSURER C :
<br />Families Fomard
<br />INSURER D
<br />8 Thomas -
<br />Irvine, CA 92618
<br />'
<br />INSURER E
<br />INSURERF:
<br />COVERAGES CERTIFICATE NUMBER: 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 />ILTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ® OCCUR
<br />X
<br />PHPK2293752
<br />71112021
<br />711/2022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGETO RENTEDPREMISS d occurrence)
<br />$ 100 ggg
<br />MED EXP An one erson
<br />20,000
<br />PERSONAL& ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY❑ 3IR�OT [X] LOG
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />GENT
<br />-
<br />PRODUCTS - COMP/OP AGO
<br />$ 3/000/000
<br />SEXUALABUSE
<br />1,000,000
<br />OTHER
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT Bf.riff$
<br />1,000,000
<br />BODILY INJURY Perperson)
<br />$
<br />X
<br />ANY AUTO
<br />PHPK2293752
<br />711/2021
<br />71112022
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILYBOODILY INJURY Per accident
<br />$
<br />X
<br />AUT030NLY X AUUTOS ONLY
<br />f-0accldea AMADE
<br />$
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />F1
<br />AGGREGATE
<br />$ 4,000,000
<br />X
<br />EXCESS L
<br />CLAIMS -MADE
<br />PHUB774554
<br />711/2021
<br />71112022
<br />LED I X RETENTION$ 10,000
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOVERS'LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE ❑
<br />FFFICCEqq(MEMBER EXCLUDED?
<br />�Mantlatory In NH)
<br />Ifna, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />WCV550516100
<br />711/2021
<br />7/112022
<br />X PER OTH-
<br />ER
<br />E. L. EACH ACCIDENT
<br />1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />A
<br />Professional (E&O)
<br />PHPK2293752
<br />71112021
<br />71112022
<br />Occurrence
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mote space Is Decal red)
<br />The City of Santa Ana, its officers, employees, agents, and representatives are named as Additional Insured on Primary and Non-C ontri bory basis with
<br />respect to General Liability coverage per attached forms as requlred In a written contract, agreement, or memorandum of understanding.
<br />30 Days Cancellation Notice unless 10 Days for Non -Payment.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cityof Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE
<br />.I s , N WeltMa&APPR2OVED
<br />.„�,� fienEvrEn&APPIt(DVED
<br />S 1'a1c4•a?`
<br />ACORD 25 (2016/03) ©1988-2015 ACORD C r -
<br />The ACORD name and logo are registered marks of ACORD - Blsk MalkgotncnEFlnll
<br />
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