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rall <br />by Tori <br />lerem <br />Tori Pierson o"g..2a2 os 0 52:10-Ono- <br />A� �® CERTIFICATE OF LIABILITY INSURANCE <br />DATE/(MNUDD2YY) <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(les) 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 />Lovett & Touchd A Marsh and McLennan Agency, LLC <br />1050 W Washington Street, Suite 233 <br />Tempe AZ 85281 <br />NAMECONTpCT Marie Shaffer <br />PHONE . 602-792-2343 ac Na <br />E-MAIL <br />ESs: mshaffer lovitt-touche.com <br />INSURERS AFFORDING COVERAGE <br />NAICM <br />INSURER A: HCC Specialty Insurance Company <br />11243 <br />INSURED NATIHOU-Cl <br />Nall's House <br />INSURER B: <br />Neutral Ground <br />INSURER C: <br />INsuRER D <br />1733 Valencia St <br />Santa Ana CA 92706 <br />INSURER E: <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 859157384 REVISION NUMRFR- <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 />BEERTYPE <br />LTR <br />OF INSURANCE <br />ADDL <br />SUB <br />POLICYNUMBER <br />POLICY EFF <br />(MMDDNYYYJ <br />POLICY EXP <br />IMMIDDIYYYY)LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />H21SS2007101 <br />1/6/2022 <br />1/6/2023 <br />EACH OCCURRENCE <br />$1,000,000 <br />DAMAGE TOR TED <br />PREMISES Ea occurrence <br />$50,000 <br />X <br />MED EXP Arry one person <br />$ 5,000 <br />1,000 <br />PERSONAL &ADV INJURY <br />$1.000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERALAGGREGATE <br />$3,000,000 <br />POLICY DJECOT r—xlLOG <br />PRODUCTS -COMPIOPAGG <br />$1,000,000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />H21SS2007101 <br />1/6/2022 <br />1/6/2023 <br />COMBINED SINGLE LIMIT <br />e accident <br />1,000,000 <br />g <br />BODILY INJURY (Par person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Pi <br />er acctlant 1 <br />$ <br />X <br />HIRED X NONOWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAR <br />CLAIMS -MADE <br />DEO <br />I I RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />PERT <br />PER OTH- <br />AND EMPLOYERS' LIABILITY YIN <br />ST ER <br />E.L. EACH ACCIDENT <br />$ <br />ANYPROPRIETORIPARTNERIEXECUTIVE ❑ <br />OFF W DEOy <br />NIA <br />E.L. DISEASE -EA EMPLOYE <br />$ <br />(Mandatory In NH) <br />If We describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />A <br />Professional Liability <br />H21SS2007101 <br />1/6/2022 <br />1/6/2023 <br />Each Claim <br />1.000,000 <br />Se alfPhysical Abuse <br />Pmt Aggregate <br />SAMLAggregale <br />3,000,000 <br />1,000.000 <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more space is required) <br />Certificate holder is named Additional Insured to General Liability coverage if required by written contract, subject to all policy terms, conditions, definitions and <br />exclusions. Primary/Non-Contributory applies. Notice of Cancellation for Specified Entity, City of Santa Ana. <br />"City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or <br />memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance carded by City shall be excess and <br />noncontributory." <br />The City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana CA 92701 <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 />ITHORIZEDREPRESENTATME RisklibmagaseedDddm <br />��7� •°�.,1k Renawm&MrRv.ID(ir.' <br />U 19BS-2U15 AGORU G( <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACME, <br />