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---ON RICHWAT-01 DPALADINO <br />1 <br />44E, <br />"J?" CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) <br />�� 9/22/2023 <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 riqhts to the certificate holder in lieu of such endorsement(s). <br />PRODUCER License # OK07568 ;OONTACT <br />Hoffman Brown CompanAngie <br />• "AH/ N 0 FAX 818 986-8510 <br />5000 Van Nuys Blvd. 6th (Alc, No):( ) <br />Sherman Oaks, CA 9140ADDRESS: <br />I SU R FFO ING O ERAGE NAIC # <br />s R :V n 20397 <br />of <br />INSURED IN, IRER B : Federal nsurance Co. 20281 <br />Richards, Wat n & Gershon INS I.. • <br />350 South Aceved <br />h r ,.��•Los Angele— <br />NS E <br />INSU ER :• • <br />COVERAGES CERTIFICATE NUMBErc REVISION NtJMRFR- <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L,6TED 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 />M/DDfYYYY) <br />POLICY EXP <br />(MM/DD1YYYY1 <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />FNF7DAMAGE <br />CLAIMS -MADE X OCCUR <br />X <br />35293250 <br />10/1I2023 <br />10I1I2024 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />TO RENTED <br />PREMISES Ea occurrence <br />1,000,000 <br />$ <br />MED EXP (Any oneperson) <br />$ 10,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY JECTPRO- PRO- X LOC <br />❑ <br />OTHER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS -COMP/OP AGG <br />Included <br />$ <br />B <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />74967929 <br />10/1/2023 <br />10/1/2024 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />1,000,000 <br />$ <br />BODILY INJURY Perperson) <br />$ <br />BODILY INJURY Per accident <br />$ <br />X <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DED RETENTION $ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR P/EXECUTIVE ❑ <br />OFFICER/MEMBER EXCLUDEXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N / A <br />71726476 <br />10/1 /2023 <br />10I1I2024 <br />X PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />1,000,000 <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />E.L. DISEASE - POLICY LIMIT <br />1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />City of Santa Ana, its employees, officers and agents are named as an Additional Insured as required by written contract per Endorsement Form #80-02-2367 <br />attached. Coverage subject to policy terms, conditions and exclusions. <br />30 day notice of cancellation applies to the certificate holder in event of cancellation except for non-payment of premium is 10 days. <br />SHOULD ANY OF THE ABOVE DE! <br />THE EXPIRATION DATE THEI <br />ACCORDANCE WITH THE POLICY <br />City of Santa Ana <br />Risk Management Division AUTHORIZED REPRESENTATIVE <br />Laura Rossini, Acting Chief Assistant City Attorney <br />20 Civic Center Plaza, 4th floor i "} <br />RFD POLICIES BE CANCELLED BFFORF <br />Risk ManagmumtDivision <br />REVIEWED & APPROVED BY. <br />� Risk Management Specialist <br />Santa Ana CA 92701 ' <br />ACORD 25 (2016/03) © 1988-2015 ACORD <br />The ACORD name and logo are registered marks of ACORD <br />