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ACO CERTIFICATE OF LIABILIPIl INSURAN E DATE(MMIDDIYYYYI
<br /> I 06/19/2024
<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 iOR ALTER THE C VERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CO TRACT BETWEEN HE 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)l must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, �ertairl policies may equire an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endors�ment(s).
<br /> PRODUCER C 1NTA e eI'll I
<br /> ® I tME: l
<br /> Gregg Stapp Insuranc is a �co�r o 8 0.
<br /> 810 E.Commonweal l• l UL sta 6 aol.com
<br /> y h rN At-RESS: PP @
<br /> I
<br /> AF 10M WNTM rl nNAIC#
<br /> Fullerton CA 92831 1, su. EUA: r r e Ny himr)(A-C&A
<br /> INSURED 1ASURL National Specialty In urance Company
<br /> Upland JRurity Group Inc. PPO#1197914 INSURE c. Z,2)ociala1615 Fr St� �201 INSURER :Sant na C J1 INSURERCOVERAGES CERTIFICATE NUMBER: EVIsibfi humMilt,.
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED ITO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY C O NTRACT 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 RED CED BY PAID CLAIMS.
<br /> ILTR TYPE OF INSURANCE INSD WVD SUER POLICY NUMBER MM DPOLIC DC MMIDIDPOLICY El(P LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000,00
<br /> CLAIMS-MADE OCCUR DAMAG ( NTE
<br /> PREMISESS Ea occurrence) $ 50,000,00
<br /> MED EXP(Any one person) $ 10,000.00
<br /> A Y Y GLO-083170 08/ 412023 08/14/2024 PERSONAL&ADV INJURY $ 1,000,000.00
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00
<br /> POLICY a PRO-
<br /> JET ©LOC PRODUCTS-COMP/OP AGG $ 2,000,000.00
<br /> I
<br /> OTHER: j Self Insured retention $ 2,500
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accidentl $ 1,000,000,00
<br /> ANY AUTO ODILY INJURY(Par person) $
<br /> B V OWNED V SCHEDULED Y Y 73APB007393 10/ 6/2023 10/26/2024 0DILYINJURY Per accident) $
<br /> /� AUTOS ONLY /� AUTOS t
<br /> X /�HIRED V NON-OWNED 'ROPER DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> $
<br /> UMBRELLA LIAB X OCCUR ACH OCCURRENCE $ 5,000,000,00
<br /> C X EXCESS LIAR CLAIMS-MADE Y Y 04171616 08/ 4/202 08/14/2024 GGREGATE $ 5,000,000.00
<br /> DED I I RETENTION S $ 5,000,000,00
<br /> WORKERS COMPENSATION ! PER OTH.
<br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER
<br /> ANY OFFICERIMEMBER EXCLUDED?ECLITIVE NIA Y
<br /> E.L.EACH ACCIDENT $
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below 1L.DISEASE-POLICY LIMIT $
<br /> Professional Liability
<br /> A Y Y GLO-083170 08/14/202 i 08/14/2024 1,000,000/1,000,C
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be atta hod if more space Is require )
<br /> The below certificate holder to be named additional insured,City of Santa Ana,its City Coun il,its officers,officials employees,agents,and
<br /> volunteers are to be covered as additional insureds with respect to liability arising out of worl or operations perfo ed by or on behalf of the
<br /> Contractor Including materials,parts,equipment,and personnel fumished in connection with such Work or operatio .Blanket Primary non Contributory
<br /> wording and Blanket Waiver of Subrogation Included
<br /> `30 day notice of cancellation applies.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City of Santa Ana SHOULD ANY OF,THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> 20 Civic Center Plaza
<br /> THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
<br /> ACCORD ACE VIIITH THE POLIO PROVISIONS.
<br /> Santa Ana,CA 92701.
<br /> AUTHO ENT E ,��°"�H�F RAManagpmad DMsion
<br /> Doug i o S 3 REvi wED 6 APPROVED BY:
<br /> �® Risk Management Specialist
<br /> ©1988- 0 D C g p
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
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