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Client#: 164812 GMBUSIN
<br /> ACORDrh, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
<br /> 2/23/2024
<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 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 any rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Sue Nisoff
<br /> EPIC Insurance Midwest PHONE •l= FAX
<br /> 560 5th Street, Suite 202 AD• EADCDREANo,Ext):SS: sue.n $Off IJt; IlJtteT4�Plb Lie •
<br /> Grand Rapids, MI 49504n ie INSURER A:
<br /> IN URER(S)AFF RDING COVERAGE NAIC#
<br /> INSURER B,Nation U yin Acevedo
<br /> INSURED Y � t�✓,�
<br /> Goforth&Marti Inc. dba GM Business
<br /> INSURERC: ate 2024 09 19
<br /> GM Business Interiors
<br /> 1099 W. La Cadena Dr. INsu R D: • f •
<br /> aRO
<br /> 0
<br /> Riverside,CA 92501P COVERAGES RTIF A U . 1 4 : 1EV7I6IU�IBeR0 7'00'
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 3Er,4 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 /> LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICYDD EFF POLICY EXP LIMITS
<br /> ( lYYYY) (POLIC YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY 5180177 03/01/2024 03/01/2025 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE X OCCUR DAMAGE
<br /> O(Ea occurrence) $300,000
<br /> MED EXP(Any one person) $25,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> PRO-
<br /> POLICY JECT LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY 2961606 03/01/2024 03/01/2025 COMBINED SINGLE LIMIT
<br /> (Ea accident) 81,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> _ AUTOS ONLY AUTOS (
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> X AUTOS ONLY X AUTOS ONLY (Per accident) $
<br /> $
<br /> UMBRELLA LIAB - OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> A WORKERS COMPENSATION WC080756387 03/01/2024 03/01/2025 X ;MUTE EMPLOYERS'LIABILITY YIN STATUTE FR
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT $1 00O O
<br /> OFFICER/MEMBER EXCLUDED? N N/A r e �0
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $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 City Council, its officers, officials, agents,employees,and volunteers are covered as additionally
<br /> insured on this policy pursuant to written contract,agreement,or memorandum of understanding.Such insurance as is
<br /> afforded by this policy shall be primary,and any insurance carried by City shall be excess and
<br /> noncontributory.30 days notice of cancellation is included.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF`
<br /> /
<br /> Risk Management Division ACCORDANCE WITH THE POLICY ` Risk Management Division
<br /> o,r �9C
<br /> 20 Civic Center Plaza REVIEWED&APPROVED BY:
<br /> Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE
<br /> �r7 °i ,
<br /> Risk Management Specialist ''
<br /> I
<br /> ©1988-2015 ACORD<cn.cwtcfary r .AU rignts reserves. \
<br /> ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br /> #S6366977/M6366941 SNI04
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