|
DAVITAU-01
<br />LBURRILL
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />/D (MMD/YYD/YY YY)
<br />1DAT4 E (MM/
<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 />Acrisure Southwest Partners Insurance Services, LLC
<br />4000 Westerly Place
<br />Suite 110
<br />CONTACT Lisa Burrill
<br />NAME:
<br />PHONE g09 766-1788 FAX
<br />(A/C, No, EXt): ( ) (A/C, No):
<br />ADMDARESS. liburrill@acrisure.com
<br />Newport Beach, CA 92660
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Sentinel Insurance Company,Ltd
<br />11000
<br />INSURED David Taussig & Associates Inc.
<br />dba DTA
<br />INSURER B : California Automobile Insurance Company
<br />38342
<br />INSURER C : Starstone National Insurance Company
<br />25496
<br />INSURER D : Hartford Casualty Insurance Company
<br />29424
<br />18201 Von Karman Ave
<br />Suite 220
<br />Newport Beach, CA 92612
<br />INSURER E : Philadelphia Indemnity Insurance Company
<br />18058
<br />INSURER F : Hartford Fire Insurance Company
<br />19682
<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 />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE [X] OCCUR
<br />X
<br />72SBAAP5439
<br />2/24/2024
<br />2/24/2025
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />1,000,000
<br />$
<br />MED EXP (Any oneperson)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />POLICY JJEC LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />190009000
<br />$
<br />X
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />BA040000030599
<br />12/19/2023
<br />12/19/2024
<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 />C
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 51000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />85717R241AL1
<br />2/24/2024
<br />2/24/2025
<br />DED RETENTION $
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? LN
<br />(Mandatory in NH)
<br />/ A
<br />72WECEU2873
<br />9/1/2024
<br />9/1/2025
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />E
<br />Prof. Liab./Claims
<br />PHSD1835820015
<br />11/1/2024
<br />11/1/2025
<br />Limit
<br />290009000
<br />F
<br />Crime
<br />72 BDD HP8140
<br />6/14/2024
<br />6/14/2025
<br />190009000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />cityclerk@santa-ana.org; FVillareal@santa-ana.org
<br />-Cyber Liability coverage with State National Insurance Company, Inc. - Policy #EHJ-ADN02027372 Eff: 7/22/24 - 7/22/25. Limit $2,000,000
<br />Excess follows form over General Liability, Automobile Liability, and Employers Liability
<br />**THIS IS A PROFESSIONAL LIABILITY (E&O) POLICY RENEWAL ONLY. ONLY PROFESSIONAL LIABILITY ENDORSEMENTS WILL BE ATTACHED. ALL
<br />PREVIOUSLY ISSUED GL, AUTO, AND WC ENDORSEMENTS ARE STILL VALID AND WILL NOT BE ATTACHED.
<br />SEE ATTACHED ACORD 101
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITY OF SANTA ANA
<br />20 CIVIC CENTER PLAZA
<br />SANTA ANA, CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03)
<br />APPROVED
<br />The ACORD name and logo are registered m By Cynthia Mora at 12:21 pm, Nov 04, 2024 1
<br />
|