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<br />ROB
<br />,a� oi2o CERTIFICATE OF LIABILITY INSURANCE
<br />OATE(MM'20204YY)
<br />s/2a/z0za
<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 endorsements .
<br />PRODUCER License #OL48969
<br />C3 Risk &Insurance Services
<br />404 Camino Del Rio S. STE 410
<br />CONTACT
<br />MP
<br />PHONE
<br />No, Eat 619 233-8000
<br />1 1: ( ) FAX No,(619) 864-7106
<br />San Diego, CA 92108
<br />E-MAILss. policy@c3insurance.com
<br />F I C
<br />NAIC #
<br />NSURERA:
<br />NY
<br />22292
<br />Angie Acevedo
<br />INSURED
<br />INSURER,: 0 a O erlC'd Ih
<br />L r a Com an
<br />36064
<br />INSURERC:GeminiInsurance Company
<br />10833
<br />NBS Government Finance Group
<br />32605 Temecula Parkway, Suite 100
<br />Temecula, CA 92592
<br />INSURER D:
<br />INSURER E :
<br />INSURER F
<br />COVERAGES CFRTIFICATF NI IRARPR- ov,n ou�.I un....r-.,.-
<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 />ILTR NSR
<br />OF INSURANCE
<br />ADDLSUBRTYPE
<br />tmgn
<br />wun
<br />POUCYNUMBER
<br />POLICYEYF
<br />POLICYEXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE [X] OCCUR
<br />X
<br />X
<br />OH3A43196311
<br />9/24/2024
<br />9/24/2025
<br />EACH OCCURRENCE
<br />2,000,000
<br />DAMAGE TO RENNTTJED
<br />PREMISES (Ea
<br />300,000
<br />rrenciO$
<br />oMED EXP (Any one erson
<br />$ 10,000
<br />PERSONAL&ADV INJURY
<br />$ 2,000,000
<br />GEN'L
<br />X
<br />AGGREGATE UMITAPPLIES PER
<br />POLICY LOC
<br />GENERALAGGREGATE
<br />$ 4,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />OTHER'
<br />A
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />AUTOS ONLY AUTOS ONLY
<br />X
<br />X
<br />AH3A42745813
<br />9/24/2024
<br />9/24/2025
<br />COMBINED SINGLE LIMIT
<br />Ea accide t
<br />1,000,000
<br />BODILY INJURY Per erson
<br />$
<br />BODILY INJURY Per accident
<br />PeFaccitlenPAMAGE
<br />$
<br />A
<br />B
<br />C
<br />X
<br />UMBRELLA LIAR
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />NIA
<br />X
<br />OH3A43196311
<br />WZ3A42745711
<br />VNPLO17038
<br />9/24/2024
<br />9/24/2024
<br />9/2412024
<br />9/24/2025
<br />9/24/2025
<br />9124I2025
<br />EACHOCCURRENCE$
<br />1,000,000
<br />AGGREGATE
<br />11000,000
<br />X EENTION$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LMBILITY
<br />ANY PROPRIETORIPARTNER/EXECUTIVE YIN
<br />F.F1dERiit�1fM1 B R EXCLUDED? F
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS be.
<br />E&O Professional Lia
<br />X PER OTH-
<br />R
<br />$DED
<br />E.L.EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. lain AggrPOLg LIMIT
<br />Ea Claim/Aggregate
<br />1,000,000
<br />$
<br />2,000,000
<br />C
<br />E&O Professional Lia
<br />VNPLO17038
<br />9/24/2024
<br />9/24/2026
<br />Deductible
<br />20,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Additional insureds are included as/where required by written contract as respects to General Liability, Auto Liability; General Liability Primary Non -
<br />Contributory wording; Auto Liability Primary Non -Contributory wording, General Liability waiver of subrogation, Auto Liability waiver of subrogation, Workers
<br />Compensation waiver of subrogation, but limited to the operations of the Insured under said contract, and always subject to all the policy terms, conditions
<br />and exclusions per endorsements attached.Cancellation provisions attached. -THIS CERTIFICATE CANCELS AND SUPERSEDES ANY CERTIFICATE
<br />PREVIOUSLY ISSUED
<br />Blanket forms apply when required by written contract:
<br />SEE ATTACHED ACORD 101
<br />SHOULD ANY OF THE ABOVE DESCF
<br />City of Santa Ana
<br />THE EXPIRATION DATE THERE(
<br />20 Civic Center Plaza (M-30)
<br />ACCORDANCE WITH THE POLICY PR
<br />P.O. Box 1988
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702
<br />ACORD 25 (2016/03) © 1988.2016 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />BEFORE
<br />-ay wrtme.lg6emv¢ Umurn
<br />T REVIEWED&APPROVED BY.
<br />A� i�ccveelo
<br />® Risk Management Specialist
<br />
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