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<br />ACORD" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY)
<br />06/20/2022
<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 />ro- Rhonda Buck
<br />rance Services
<br />I Moorpark Avenue, #104
<br />Jose, CA 95117
<br />ro Agents&Brokers Ins Sery
<br />Ste. K
<br />Allmerica Financial
<br />Ins
<br />Ins Co#22306
<br />CnvPPAr:FC rFRTIFICATF NI IMRFR- RFVISION NUMRFR-
<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 />TYPE OF INSURANCE
<br />ADOL
<br />Wvn SUB R�
<br />POLICY NUMBER POLICY EFF
<br />POLICY EXP
<br />_
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE occuR
<br />OZFD95532203 07/0112022!
<br />07/01/2023
<br />EACH OCCURRENCE
<br />11000,000
<br />DAMAGE TO RENTED
<br />$ 300,000
<br />MED EXP An one arson
<br />_
<br />S 10,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />X POLICY PE€T LOC
<br />OTHER:
<br />PERSONAL&ADV INJURY
<br />g 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />_
<br />PRODUCTS - COMPIOP AGG
<br />2,000,000
<br />C
<br />AUTOMOBILE LIABILITY
<br />X ANY AUTO
<br />ED AUTOpSyUyLEOp
<br />AUTOOS ONLYN
<br />X AUTOS ONLY AUTOS ONLY
<br />'AWFD95530603
<br />07/01/2022 07/01/2023
<br />COMBINED SINGLE LIMIT
<br />$ 1,0001000
<br />BODILY INJURY Par arson
<br />BODILY INJURY Per aaitlent
<br />$
<br />Llaconidenl AMAGE
<br />_,
<br />$
<br />A
<br />UMBRELLA LIAR
<br />EXCESS LIAR
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />OZFD95532203 07101/2022'107101/2023
<br />EACH OCCURRENCE
<br />3,000,000
<br />X
<br />AGGREGATE
<br />_
<br />$ 3,000,000
<br />DED I X I RETENTION$ O'.
<br />D
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY Y/N�
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED] n
<br />(Mandatory In NH)
<br />I(yes, tlesaibe under
<br />DES RIPTI N FOPERATIONSbL_
<br />!
<br />!NIA
<br />WDFD92893203 i07/01/2022
<br />07/01/2023
<br />PER OTH-
<br />_X:STRTS
<br />EL EACH ACCIDENT
<br />_
<br />$ 1,000,000
<br />E.L. DISEASE, EA EMPLOYEE
<br />$ 1,000,000
<br />E. L. DISEA E -POLICY LIMIT
<br />1,000,000
<br />B
<br />Professional Liab.
<br />Deductible $50,000
<br />USS2232978 07/01/2022
<br />i
<br />07/01/2023 Ea. Claim
<br />Aggregate
<br />2,000,000
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLE$ (ACORD 101, AddlUanal Remarks Schedule, may be attached If more space Is required)
<br />SEE ATTACHED ADDENDUM.
<br />30 day notice of cancellation except 10 days when for nonpayment of premium.
<br />RE: N-2021-097
<br />CITY-15
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cityof Santa THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Mgmt Division
<br />20 Civic Center Plaza 4th Fir AUTHORIZED REPRESENTATIVE RIAM..g.jduw�
<br />Santa Ana, CA 92701 RENEY/ED&AFF\ _ �fC
<br />AUUKU Z5 (2U1e/U3) ©1988-2015 ACORD CC --
<br />The ACORD name and logo are registered marks of ACORD
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