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( on I Jerson Dxtr 11:49:26
<br />AC o® CERTIFICATE OF LIABILITY INSURANCE °'Da
<br />°ATE'MMr°°""""'
<br />06/1412022
<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 Erica Hornaday
<br />NAME:
<br />The Empire Company
<br />PHONE FA%
<br />A/CON
<br />No Ext: AX No:
<br />550 North Park Center Drive
<br />ehornaday(a�empire-co.com
<br />AODRESs:
<br />Suite 205
<br />INSURERIS) AFFORDING COVERAGE
<br />10
<br />INSURERA: Sentinel Insurance Company, LTD
<br />11000
<br />Santa Ana CA 92705
<br />INSURED
<br />INSURERS: Trumbull Insurance Company
<br />27120
<br />RSG, Inc.
<br />INSURER C: Argonaut Insurance Company
<br />19801
<br />17872 Gillette Ave., Suite 350
<br />INSURER D:
<br />INSURER E:
<br />Nine GA 92614
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 2022/20232nd Updt Master 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 OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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 />TYPEOF INSURANCE
<br />ADDIL
<br />INSO
<br />BUSS
<br />WVD
<br />POLICY NUMBER
<br />POLICY SEE
<br />MMyDDNYYY
<br />POLICY
<br />MMIDDWYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />�/
<br />CLAIMS -MADE x OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />D GETO 111
<br />PREMISES Ea occurrence
<br />$ 1,000,000
<br />MED EXP (Any one Person)
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />Y
<br />72SBAAQ7019
<br />01/01/2022
<br />01/01/2023
<br />GENTAGGREGATE LIMITAPPLIES PER:
<br />X POLICY ❑ JECT PRO ❑
<br />LOG
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />CTS-
<br />PRODUCOMPIOPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINEDSINGLE LIMIT
<br />Ea accident)
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Y
<br />72SBAAQ7019
<br />01/01/2022
<br />01/01/2023
<br />BODILY INJURY(Peracciden0
<br />$
<br />X
<br />HIRED v NON -OWNED
<br />AUTOS ONLY /� AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per al$
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />x
<br />AGGREGATE
<br />$ 2,000,000
<br />A
<br />EXCESSLIAB
<br />CLAIMS -MADE
<br />72SBAA07019
<br />01/01/2022
<br />01/01/2023
<br />DED
<br />X RETENTION $ 101000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YIN
<br />ANY PROPRIMBEREXCL EXCLUDED?
<br />EXCLUDED'!
<br />(Mandatory
<br />(fyes,doryin NH)
<br />NIA
<br />Y
<br />72WECVK8727
<br />01/0V2022
<br />01/01/2023
<br />PER OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,o0D,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />e under
<br />DESCRIPTION OF OPERATIONS below
<br />DESCRIPTION
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />Errors &Omissions
<br />AGGREGATE LIMIT
<br />$4,000,000
<br />C
<br />Cliams Made
<br />12lMPLO167514-02
<br />03/01/2022
<br />03/01/2023
<br />EACH CLAIM
<br />$2,000,000
<br />DEDUCTIBLE
<br />$10,0()0
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES IACORD 101, Additional Rama rks Sol le, may be affached If more apace Is required)
<br />RE: Agreement A-2021-192-01 Affordable Housing Financial, Analytical And Advisory Services.
<br />City of Santa Ana, its agents, officers, officials, employees, and volunteers are named as additional insured on this policy pursuant to written contract,
<br />agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City shall be
<br />excess and non-contributory under the General Liability, where required by written contract, per form (SS 41 71 12 19) and (SS DO 08 04 05). Completed
<br />Operations additional insured applies per form (SS 41 71 1219). General Liability is Primary and Non -Contributory per form (SS 00 08 04 05). Auto Iiabiity
<br />additional insured per form SSO4380909 attached. General Liability and Worker's Compensation Waiver of Subrogation per forms (SS 00 08 04 05) and (WC
<br />04 03 06).
<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 Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92702 TWb44.
<br />V I I PAMmvgmmntDMrtor
<br />©1988-2015 ACORD CDR �''-. ,rl,h 8enewaD6AwRavm 6r.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD " %xG j�CSW9r5
<br />Rkk Marmaemmt CIoncsrAirle
<br />
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