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ACORO® CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDDIYYYY) <br />4/30/2024 <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 INSURERS), 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 />Venbrook Insurance Services <br />16815 Von Karman Avenue <br />Suite 180 <br />Irvine, CA 92606 <br />CONTACT <br />Michele Baled <br />PHONE FAx <br />818-598-8900 ac No 949 652.3980 <br />ADDRESS: certifica venbrook-com <br />INSURERS AFFORDING COVERAGE <br />NAICC <br />INSURERA: Travelers Casualty Insurance Co of America <br />19046 <br />www.venbrook.com CA Lie No. OD80832 <br />INSURED <br />Monument ROW <br />200 Spectrum Center, Suite 300 <br />Irvine CA 92618 <br />INSURER B: Travelers Properly Casualty Co of America <br />25674 <br />INSURER c: Underwriters at Lloyds of London <br />15642 <br />INSURER O: <br />11512 <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 7R779Rn6 REVISION NUMRFR- <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 />ADOL <br />SUBR <br />POLICYNUMBER <br />POLICY EFF <br />NIWDD <br />POLICY UP <br />MIND <br />LIMITS <br />A <br />TVCoMMERCMU. GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />✓ <br />✓ <br />6807P4562802442 <br />4/23/2024 <br />4/23/2025 <br />RENCE <br />EACH OCCURGE <br />$1000000 <br />To NTED <br />PR MSES Ea ucwmrence <br />S300000 <br />MEO UP (Any one person) <br />$5 000 <br />uctible: none <br />PERSONAL A ADV INJURY <br />$1 000.000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />✓ POLICY [:]ECT C- J❑LOG <br />GENERALAGGREGATE <br />$2,000,000 <br />PRODUCTS-COMP/OP AGG <br />$2000.000 <br />$ <br />OTHER <br />A <br />AUTOMOBILELIABILITY <br />6807P4562802442 <br />4/23/2024 <br />4/23/2025 <br />OMeBYNEeDISINGLE LIMIT <br />$1,000000 <br />BODILY INJURY (Per Person) <br />$ <br />ANYAUTO <br />OWNED LED <br />AUTOSONLYHAUT0ESR'UHIRED <br />BODILY INJURY Peracdtlent <br />( ) <br />$ <br />✓ <br />P'� <br />AUTOS ONLY AUTOS ONLY <br />(Pat ide DAMAGE <br />$ <br />B <br />,y <br />UMBRELLALUUI <br />✓ <br />OCCUR <br />CUP5N8889392442 <br />4/2312024 <br />4/23/2025 <br />EACH OCCURRENCE <br />$5000.000 <br />AGGREGATE <br />$5000,000 <br />EXCESS UAB <br />CLAIM&MADE <br />DIED I ✓ I RETENTION$0 <br />$ <br />B <br />WORKERSCOMPENSATION <br />AND EMPLOYERS' LIABILRY YIN <br />ANYPROPRIETOWPARTNERIEXECl1TNE <br />OFRCERIMEMBEREXCLUDED1 Y <br />NIA <br />✓ <br />UB2Y3528922442G <br />4/23/2024 <br />4/23/2025 <br />✓1 STATUTEI I°ERTM <br />EL EACH ACCIDENT <br />$1,000000 <br />EL DISEASE -EA EMPLOYEE$1 <br />jt. 000 <br />(Mandatory In NH) <br />Uyes de6Crbe under <br />DESCRIPTION OF OPERATIONS below <br />EL DISEASE - POLICY LIMIT <br />$1000000 <br />C <br />Professional Liability (Claims Made <br />MPL444730524 <br />4/23/2024 <br />4/23/2025 <br />$2,000,000 Each Claim/ Aggregate Limit <br />8 Reported) <br />Retention: $5,000 Each Claim <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />RE: The City of Santa Ana, its officers, employees, agents, and representatives are named as Additional Insured in respects General Liability <br />per form CGD105 0494. Primary/Non-Contributory form CGT1000219, Waiver of Subrogation form CGD842 0219, WC040306 4-84 applies in favor of the <br />Additional Insured when required by written contract. 30 Day Notice of Cancellation per policy provisions. Subject to policy terms, conditions <br />and exclusions. <br />City Of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana CA 92701 <br />1UTHOROEDREPRE5ENTATNE n <br />Gabriela Covarrubias <br />©1988-2015 ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF NOTIr'F Will I RF nri IVFRFn IN <br />ACCORDANCE WITH THE POLICY PRC <br />Risk MamagonmEniwinn <br />REVEWEG&APPR AaECBY: <br />rl <br />ftr 444 <br />®'. <br />® Rlsk Management Specialist <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />[J2-0 C NO, UN3, WC, PL Gaoiiela Covaccobi— 1 4/30/2024 S:C2:02 Pt' PUT) I Page 1 n2 a <br />I't'_•:.-=ic-_scat= cancels and supersed=_s ALL previously issued certificates. <br />