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I VII FIC13V 11 012021.11.0309a3:1407'pU•
<br />ERGO&AP-01 _ LMORGAN
<br />,a►Iiii CERTIFICATE OF LIABILITY INSURANCE
<br />CERTIFICATE
<br />DATED/V1'V
<br />1l(2/2021
<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 eNndorsement(s).
<br />PRODUCER
<br />CO
<br />JACT Laura Morgan
<br />All iant Insurance Services Inc.
<br />3977 Harbour Pointe Blvd SW
<br />Mukilteo, WA 98276
<br />PHONE
<br />(A/C,
<br />FAX
<br />No, Exty (425) 740-5207 (A/C, No):
<br />AooalEss: Laura.Morgan@alliant.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIL 0
<br />INSURERA: Underwriters at Lloyd's London Illinois
<br />15792
<br />INSURED
<br />National Testing Network Inc
<br />2122 SuihStSW
<br />te OO
<br />INSURERS: American Fire and Casualty Company
<br />24066
<br />INSURER c: Evanston Insurance Com any
<br />35378
<br />INSURER D:Technology InsuranceCom an Inc
<br />42376
<br />INSURER E:
<br />Lynnwood, WA 98087
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER RPVIRIfIM MI IIVI
<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 />ILTR
<br />TYPE OF INSURANCE
<br />ANSD
<br />SWVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIVYYY)
<br />POLICY UP
<br />IMMIDOIYYYYJ
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />PSK0134050843
<br />10/2712021
<br />10/27/2022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE
<br />3ETOR NT r0PREMence
<br />$ 250,000
<br />MED UP (Any oneperson)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO LOU
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />X
<br />PRODUCTS - COMP/OP AGO
<br />$ 11000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BAA68229925
<br />10/2712021
<br />10/2712022
<br />BODILY INJURY Per parsom
<br />$
<br />BODILY INJURY Peraccident
<br />S
<br />ATOD ONLY AUTOS ONL�
<br />Pe�accRdYIDAMAGE
<br />$
<br />$
<br />C
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS MADE
<br />XOBW9134921
<br />10127/2021
<br />1012712022
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />X
<br />AGGREGATE
<br />$ 2,000,000
<br />DIED RETENTION$
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED'! �
<br />(Mantlatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />TWC4023781
<br />10/27/2021
<br />1012712022
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - I EMPLOYE
<br />$ 11000,000
<br />E.L DISEASE - POLICY LIMIT
<br />S 1,000,000
<br />A
<br />Professional Liab
<br />PSK0134050843
<br />10127/2021
<br />10/2712022
<br />$6,000Ded; Ea Occ/Agg
<br />3,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />RE: NTN Testing Services
<br />City of Santa Ana its officers, employees, agentsvpnd representatives are Additional Insured with respect to the General Liability perform attached. General
<br />Liability coverage is Primary Non -Contributory per form attached. Notice of Cancellation, Non -Renewal and Material Change on General Liability and
<br />Professional Liability applies per forms attached.
<br />City of Santa Ana
<br />Risk Management Division
<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 PROW......
<br />W kMtim,gcrnmtDhidm
<br />JTHORIZED REPRESENTATIVE {
<br />a REVIE.4EDSAPPpovm BY:
<br />Ll�i.' Tort x!tm4oa
<br />�— —� rr aMa„es�amrae2�Iade
<br />ACURU 20 (2U1 ti © 1988-2015 ACORD CC v .re
<br />The ACORD name and logo are registered marks of ACORD
<br />
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