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olguanr signed by mn <br />o <br />Tori Pierson e,:nozl ob xe ,o,vs, <br />0700 <br />A� o® CERTIFICATE OF LIABILITY INSURANCE <br />°"'3"""°°"Y"" <br />3/211'2022 <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 be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement a . <br />PRODUCER <br />Cobbs, Allen & Hell, Inc. <br />N S Office Park Drive, Ste 200 <br />NM1NT <br />E;IT Cads Matthews <br />PHoNE FAx <br />12058743611 c xo , 20r.414-8105 <br />ADH . Cmatthews cobbsallen.com <br />Birmingham AL 35223 <br />INSUR ERS AFFORDING COVERAGE <br />NAICI <br />WSURER A: Transportation Insurance <br />20494 <br />INSURED INTEINT-01 <br />Intercoast International Training, Inc. <br />PO Box 3585 <br />Wsui B : Continental American Ins. Co. <br />71730 <br />INSURER C :National Fire Ins. of Hartford <br />20478 <br />WsuRERo: Securi National Ins Co <br />33120 <br />Attn: Geeta Brown <br />Granada Hills CA 91394 <br />WSUsee E: <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 1130876120 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 TH S <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 />WSR <br />LTR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFF <br />MmOJYYYY <br />POLICY EXP <br />MIDD <br />LIMITB <br />C <br />OENEal LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CVJMS4ADE aOCCUR <br />Y <br />7012418241 <br />W12QC22 <br />31IM023 <br />EACHCCCURRENCE <br />01,000." <br />PREMISE Me txcurtmoel <br />$100,000 <br />MED EXP (Any one <br />S15,000 <br />PERSONAL&ADVINJURY <br />31,OxLoo0 <br />GLNERAL AGGREGATE <br />$2,000,000 <br />GEN'L AGGREGATE <br />X POLICY <br />LIMIT APPLIES PER: <br />jO" LOC <br />PRODUCTS -COMPIOP AGG <br />$2.000,000 <br />$ <br />A <br />AUTOMOBILELIABILIY <br />ANY AUTO <br />ALLOWNED SCHEDULED <br />AUTOS ALITOS <br />R DAUTOS NON -OWNED <br />X <br />mH48sB938 <br />W122022 <br />V122023 <br />COMBINED SINGLE LIMIT <br />Es scment <br />BODILY INJURY(Psr person) <br />S <br />BODILY WJURY(Fix sCCMedr) <br />S <br />PrDAMAGE <br />(e. <br />$X <br />$ <br />B <br />X <br />UMBIIELLAUAB <br />EXCESS UAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />7014700425 <br />wimp 1 <br />WwOt4S <br />EACH OCCURRENCE <br />S5,000,000 <br />AGGREGATE <br />S Soixi'm <br />CEO I X I RETENTION 3101100 <br />E <br />D <br />O <br />WORKERS CCMPENBATION <br />AHDEMPLOYERS'LIABRTTY YIN <br />ANY PROPRIETOR,PARTNERI ECUTIVPr <br />DFFICEFUMEMSER EXCLUDED? <br />(Mandalay In NH) <br />nym, desvlas un0sr <br />DESCRIPTION OFOPERATIONS below <br />NIA <br />SWC137013 <br />SWC1379513 <br />W102022 <br />2/102022 <br />2I102020 <br />2n 012023 <br />WC TORY IAT <br />MIT DTH- <br />EL EACH ACCIDENT <br />�E. <br />sI'M,o00 <br />L.DISEASE-EA EMPLOYE <br />S1,o00o00 <br />E.L. DISEASE - POLICY LIMIT <br />$1o00000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ANsch ACORD 101, AddlVeml Remsdis Schedule. H mom spew is mulmd) <br />City of Santa Ana Workforce Training Program. City of Santa Ana, officers, agents, employees, and volunteers are named as additlonal Insureds as respects <br />General Liebillity, as required by written Contract, agreement, or memorandum of understanding. Such Insurance as is afforded by this policy shall be primary, <br />and any insurance Carried by City shall be excess and noncontributory. <br />30 days notice of Cancellation applies per policy terms and conditions <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 />20 Civic Center Plaza <br />Risk Management Division AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92702 RMtA1R+geaatwwPn <br />/ REVIEwo 6 APPRCATE, <br />© 8mr <br />r. <br />.2010 ACORD CORR .a^ ?dw pw;,t <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1('�___.- Rue Ma,uga„m, Chdml Ad, <br />