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Digitally signed by Tod Pierson <br />Tori PiersonDate: 2022.07.05083532 <br />-m'eo <br />ACOR ' CERTIFICATE OF LIABILITY INSURANCE <br />DATE(M"DO"YYY( <br />`� <br />06/28/2022 <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 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 />Vazquez Prado Insurance Services <br />18301 Von Karman Ave Suite 560 <br />CONTACT <br />FN <br />arc.N Ent: 714-425-1632 1ac No): 844 z7a oozo <br />ADDRESS: customemeMce@vazguezpmdo.com <br />Irvine, CA 92612 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURER A : Rockingham Insurance Company <br />10214 <br />INSURED <br />Harrison Building <br />4533 Macarthur Blvd <br />INSURER B : Infinity Select lnsumnce Company <br />22266 <br />NSURERC: <br />#578 <br />INSURER D : <br />Newport Beach, CA 92660 <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER:26000522 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 />ILTR <br />TYPE OF INSURANCE <br />INSD <br />MD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY EX <br />MMIDDNYYY LIMITS <br />A <br />,/ <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE I J OCCUR <br />X <br />X <br />RCAA306205-01 <br />08/05/2021 <br />08/05/2022 EACHOCCURRENCE <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ 1,000,000 <br />$ 50,000 <br />$ 5,000 <br />MED EXP (Any one person) <br />$ 1,000,000 <br />PERSONAL &ADV INJURY <br />$ 2,000,000 <br />GENT <br />AGGREGATE LIMIT APPLIES PER. <br />GENERAL AGGREGATE <br />POLICY ✓ PROJECT LOC. <br />i <br />PRODUCTS-COMP/OP AGO <br />$ 2,000,000 <br />THER: <br />B <br />AUTOMOBILE <br />LIABILITY - <br />- <br />504-61Q16-1432-001 <br />08/12/2021 <br />08/12/2022 COMBINED <br />$ 1,000,000 <br />$ <br />ANY AUTO <br />BODILY INJURY (Per person) <br />✓ <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />HIRED NON -OWNED <br />UTOS ONLY AUTOS ONLY <br />- <br />PROPERTYDAMAGE <br />Per accident <br />$ <br />$ <br />UMBRELLA UAB <br />CCUR <br />- <br />EACH OCCURRENCE <br />$ <br />EXCESS LIAB <br />LAIMS-MADE <br />AGGREGATE <br />$ <br />DED RETENTION S <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY /N <br />BTATUTE 77— <br />ER <br />$ <br />ANYPROPRIETORIPARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />NIA <br />- <br />E.L. EACH ACCIDENT <br />EL DISEASE - EA EMPLOYEE <br />$ <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) <br />City of Santa Ana, Risk Management Division is listed as an additional insured per the blanket additional insured endorsement <br />if required by written contract or agreement <br />CERTIFICATE HOLDER <br />CANCELLATION <br />City of Santa Ana <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Risk Management Division <br />9 <br />0 Civic Center Plaza <br />Santa Ana, CA 92702 <br />THE EXPIRATION DATE THEREOF, 30 DAY NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROV <br />RiA,aboag,,,,,,�,,, <br />AUTHORIZED REPRESENTATIVE "-. Rsm 5 &APPR�mBY <br />s %u Pro. <br />�v � RUNMmagertal ClmralNtle <br />© 1988-2015 ACORD C( <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />26000522 1 RCAA306205-01 1 504-61016-1432-001 1 22/23 Maa[e[ Cei¢ificaie 06/23/2022 10:40:37 AM(PDT) <br />