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STAGPLU-01 NEHAVARSHA <br />ACORO"° CERTIFICATE OF LIABILITY INSURANCE <br />`..•--''" <br />DATE(MM/DD/YYYY) <br />5/26/2022 <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 />CONTACT Sherry Parlan <br />PHONE FAX <br />(A/C, No, Ext): (858) 869-8331 (A/C, No): (858) 869-8301 <br />NFP Property & Casualty Services, Inc. <br />1551 North Tustin Avenue <br />Suite 500 <br />E-MAIL Sherry.Parlan@nfp.com <br />Santa Ana, CA 92705 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURERA:Ohio Security Insurance Company <br />24082 <br />INSURED <br />INSURER B: American Fire and Casualty Company <br />24066 <br />INSURER 7 <br />Stage Plus, Inc. <br />INSURER D : <br />P.O. Box 11060 <br />Santa Ana, CA 92711 <br />INSURER E <br />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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDD/YYYY <br />POLICY EXP <br />MMIDD/YYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE X OCCUR <br />X <br />X <br />BKS58241997 <br />7/29/2021 <br />7/29/2022 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />500,000 <br />$ <br />MED EXP (Any oneperson) <br />$ 15,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />POLICY X JECT El LOC <br />PRODUCTS - COMP/OPAGG <br />$ 2,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY Perperson) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY Per accident <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />B <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 2,000,000 <br />X <br />EXCESS LIAB <br />CLAIMS -MADE <br />ESA64850012 <br />5/24/2022 <br />7/29/2022 <br />AGGREGATE <br />$ 2,000,000 <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />PER OTH- <br />STATUTE ER <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ <br />OFFICER/MEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />N/A <br />E.L. 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 / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />The City of Santa Ana, its officers, officials,employees, and volunteers are named Additional Insured as respects to General Liability including Completed <br />Operations. This insurance is primary and non-contributory with any other insurance of the additional insured, so long as a written contract or agreement to <br />such exists prior to a loss. A Waiver of subrogation in favor of the additional insured applies as respects to General Liability coverage so long as written <br />contract or agreement exists. 30 days' notice of cancellation applies as per attached endorsements CG 88 10 04 13, CG 20 37 04 13 and CG 80 6105 11. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ty ACCORDANCE WITH THE POLICY PROVISIONS. <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE <br />,n cERisk kluagmentDD BY <br />an <br />REVIEWED & APPROVED BY: <br />ACORD 25 (2016/03) © 1988-2015 ACORD I �l <br />The ACORD name and logo are registered marks of ACORD '— Risk Management Specialist <br />