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A n n10 Digitally signed
<br />A��® ir .1 1 %. r 9Ail.{Pppi DIYYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE .L A ^ " Cat A 22
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON T E H(�1' DER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGEA F R E B fHE7�'Qt':IFR
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUIN INSURER(',), Auj71�f 4&.23
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL I or C p' ovisions 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 endarsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME: Roan Valera, Policy Services Representative
<br />Chrysalis Insurance Agency (Incorporated)
<br />NGNNo Ext : (714) 464-8080 (a/c, No):
<br />ADDRESS: roan@ciapro.net
<br />3001 Red Hill Ave, Ste. 2-226
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: ARCH SPECIALTY INS CO
<br />21199
<br />Costa Mesa CA 92626
<br />INSURED
<br />INSURERS: AMGUARD INS CO
<br />42390
<br />Sunny Hills Associates Inc. d/b/a SUNNY HILLS RESTORATION
<br />INSURER c: MIDWEST EMPLOYERS CAS CO
<br />23612
<br />1999 RITCHEY ST
<br />INSURER D :
<br />INSURER E :
<br />SANTA ANA CA 92705-5100
<br />1 INSURER F:
<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 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 />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />(MM/DDIYYYY)
<br />(MMIDDNYYY)
<br />LIMITS
<br />A
<br />x
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FxI OCCUR
<br />Y
<br />Y
<br />12 EMP 22242 02
<br />05/15/2022
<br />05/15/2023
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PREMISES (Ea occurrence)
<br />$ 100,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GVEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑JECOT FILOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />EOWNED
<br />AUTOMOBILE
<br />LIABILITY
<br />y SCHEDULED
<br />AUTOS ONLY /� AUTOS
<br />HIRED y NON-OWNEDAUTOS ONLY /� AUTOS ONLY
<br />Y
<br />Y
<br />SUAU379522
<br />04/10/2022
<br />04/10/2023
<br />(Ea accitlent)
<br />$ 1,000,000
<br />J)CANYAUTO
<br />BODILY INJURY(Per person)
<br />$ 1,000,000
<br />BODILY INJURY(Per accident)
<br />$ 1,000,000
<br />(Per accident)
<br />$ 1,000,000
<br />A
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />x
<br />OCCUR
<br />CLAIMS -MADE
<br />Y
<br />Y
<br />12 EMX 22243 02
<br />05/15/2022
<br />05/15/2023
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X
<br />AGGREGATE
<br />$ 1,000,000
<br />OFO
<br />I I RETENTION$
<br />PRODUCTS/COMPLET]
<br />$ 1,000,000
<br />C
<br />ORKERS COMPENSATION
<br />ND EMPLOYERS' LIABILITY YIN
<br />FFICER/MEMBER EXCLUDED? PROPRIETOR/PARTNERIEXECUTIVE❑
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />Y
<br />BNUWC0155323
<br />11/14/2021
<br />11/14/2022
<br />A� -
<br />/� STATUTE 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 />CONTRACTORS POLLUTION
<br />LIABILITY
<br />12 EMX22243 02
<br />05/15/2022
<br />05/15/2023
<br />Per Occ/Agg
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />City of Santa Ana, Its Officers, Agents and Employees, Vendors are named as additional insured per attached ECP 1004 04/10. 30 days notice of cancellation
<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 AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701 REmEwED&APPROVED BY:
<br />©1988-2015 ACORI 9 i; A+,�s AawcAo
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD '' Risk Managemenl5petl.Yisl
<br />
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