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Francine R, Villareal hl°a I`la"aanrFmna"nn
<br />CAMFOR na Dafca0x 1.a1.nikeeS oTep'
<br />HC'CJO�R 7"
<br />-- CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDUh-M)
<br />s/30/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
<br />CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED
<br />BELOW. THIS CERTIFICATE
<br />BY THE POLICIES
<br />OF INSURANCEDOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the
<br />pollcy(les) must have ADDITIONAL INSURED
<br />If SUBROGATION IS WAIVED, sub)act to the terms and conditions of
<br />this certificate does not confer righta to the
<br />provisions or bo endorsed.
<br />the Policy, Certain policies may require an endorsement. A statement
<br />certificate holdor in Ile u of such
<br />PRODUCER License IF OM1 U410
<br />endorsements . on
<br />ArmstronglRobitallle/Rlegle Business and Insurance Solutions
<br />% TACT
<br />P�y{p.•II E
<br />IMIV, rak, S.M 949 381-7700 AAic, No: 949 487-8151
<br />830 Roosevelt, Suite 200
<br />Irvine, CA 92620
<br />.arrinfo@alera rOU .Dom
<br />INSURER 8 FP08IDINO 9PYBRAGS NAIC
<br />INsu ERA •Phil dI hla IndemnityIns Co 18058
<br />' INSURED
<br />INS AERB;COm West Insure --- man 12177
<br />Families Forward
<br />IN uaea
<br />B Thomas
<br />INSURER
<br />Irvine, CA 92618
<br />INSURER E:
<br />INSURER F:
<br />C
<br />E GES CERTIFICATE
<br />U BE -
<br />LISTED BELOW HAVE
<br />R ISION NUMBER,
<br />THIS
<br />IS TO CERTIFY THAT THE POLICIES
<br />OF
<br />INSURANCE
<br />INDICATED.
<br />CERTIFICATE
<br />NO ANY
<br />MAY BE ISSUED OR MAY
<br />REQUIREMENT,
<br />PERTAIN,
<br />TERM OR CONDITION OF
<br />BEEN ISSUEDTO
<br />ANY CONTRACTOR
<br />THE INSURED
<br />OTHER
<br />NAMED ABOVE FOR THE POLICY PERIOD
<br />DOCUMENT WITH. RESPECTTO WHICH
<br />EXCLUSIONS
<br />AND CONDRIONS OFSUCH
<br />POLICIES.
<br />THE INSURANCE AFFORDED BY
<br />LIMITS SHOWN MAY HAVE
<br />THE POLICIES
<br />DESCRIBED
<br />THIS
<br />HEREIN$ SUBJECT TO ALL THE TERMS,
<br />TYPE OF INSURANCE
<br />ADDLSUSR
<br />SEEN
<br />POLICY NUMBER
<br />REDUCED BY
<br />POLICYEFF
<br />PAID CLAIMS.
<br />POLdCY EXP
<br />A
<br />X COMMERCIAL GENERAL LIASILRY
<br />0
<br />LIMITS
<br />71
<br />CLAIMS•MAOE X OCCUR
<br />X
<br />PHPK2293752
<br />711/2021
<br />711/2022
<br />EACH OCCURRENCE $ 1,000,000
<br />PR GET NTED
<br />I $ 10Q000
<br />MEDEXBP one e n 20,000
<br />PERSONAL & ADVINJURY t 1,000,000
<br />GUNLAGOREGATELIMRAPPLIES
<br />PER:
<br />POLICY P LOC
<br />GE NE OREGA 3,000,DOO
<br />CD /0 AGO 3,000AN PRX UC'I'S-
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />3EXUALABUSE 1,000,000
<br />X
<br />ANYAUTC
<br />PHPK2293752
<br />711/2021
<br />7/1/2022
<br />EMS EDSINGLELIMIT 1,000,000
<br />AAryL�pTOS ONLY REIRESL EDn
<br />SODgyINJURY Pef son
<br />X
<br />AUT�3 ONLY X A06
<br />INIUR�GE nddenl
<br />ADOPEJY
<br />ONLY
<br />A
<br />UMBRELLA LIAR 'X OCCUR
<br />X
<br />EXCESS LIAR CLAIMS•MAOE
<br />PHUB774554
<br />7/112021
<br />7/1/2022
<br />ENCE 4,000,000
<br />OED X RETENTION$ 10,000
<br />4,000,000
<br />g
<br />waaRKERS COMPS,ySA7IIppN
<br />Af10 RMPLOYERS'CLAST LITY
<br />YIN
<br />ANYPR�O�PgIgTOR/PARTNERtXEcuTIVE
<br />WCV550516100
<br />1/1/2021
<br />71t12022DE
<br />ETH-
<br />1,POD,000
<br />WEPLOYE
<br />foryE9E%CLUDED4NIAfyySAE
<br />UESCRIPTIOND 0 ERATIO SbelowA
<br />PLOYS 1,000,00D
<br />Professional (E&O)
<br />PHPK2293752
<br />7l1l202171112
<br />222
<br />PoLl YUMIT 1,000,00C
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addlllenei Remark, Schedule, may be alkched If mono e0aoe le r,gUlfed)
<br />The City of Santa Ana, Its officers, employees, Booms, and representatives
<br />AYe named as Additional Insured on Primary and Non•Coniribory heals with
<br />respect to General Liability coverage per attached forms as required In a written contract, agreement, or memorandum
<br />of understanding,
<br />30 Days Cancellation Notico unless 10 Days for Non -Payment.
<br />CERTIFICATF_ NDI_nFR
<br />City of Santa Ann
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, N0710E WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />AUTHORIZED REPRESENTATIVE a
<br />ACORD 25 (2018/03) - 05.,.
<br />01988.2015 ACORD C ,
<br />The ACORD name and logo are registered marks of ACORD "NSI R! MaRa9r mAITRiyaf
<br />
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