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CUR®� CERTIFICATE OF LIABILITY INSURANCE F02;128/20;25
<br /> ATE[MbD'YYYY)
<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 endorsemont(s).
<br /> PRODUCER NAME: Paychex Insurance Agency Inc
<br /> PAYCHEX INSURANCE AGENCY,INC. PHONE 877-266-6850 FAIL No: 585-385-7426
<br /> 225 KENNETH DRIVE E-MAIL cedsQpaychex.wm
<br /> ROCHESTER,NY 14623 ADDRESS:
<br /> INSURER 5 AFFORDING COVERAGE NAIC d
<br /> INSURERA:Sentinel Insurance Company, LTD
<br /> INSURED INSURERS: Sequoia Insurance Company
<br /> PROUDCITY INSURERC:Hartford Fire Insurance Company
<br /> DBA PROUDCITY INSURERD:
<br /> 2219 DAMUTH ST INSURERE:
<br /> OAKLAND, CA- 94602 INSURER P:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 ADDL SUER
<br /> LTR TYPE OF INSURANCE POLICY NUMBER POLIGYEFF POLICYEXP
<br /> rNsr) wynMMIDDIYYYYI IMMIDDIYYYYI LIMITS
<br /> X COMMERCIALGENERALUABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X❑OCCUR DAMAGE TO RENTED
<br /> PREMISES Ea occurrence $ 1,000,000
<br /> X X MED EXP "ore person) $ 10,000
<br /> A 76S B M B C3 RO R 07/05/2024 07105/2025 PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $.2,000,000
<br /> X POLICY 0 JEGT PRO- ❑
<br /> LOG PRODUCTS-COMPIOP AGG $ 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED
<br /> MBI EDSINGLELlMIT $ 1,000,000
<br /> ANYAUTO AUTOS v BODILY INJURY(Per persor) $
<br /> AOWNED AUTOSSCHEDULED X ^ 76SBMBC3ROR }
<br /> AUTOS ONLY 07/05/2024 07/05/2025 BODILY INJURY(Per accident $
<br /> X HIRED Ix
<br /> NON•OWNED PROPERTYDAMAGE
<br /> AUTOS ONLYAUTOS ONLY Per eeldent $
<br /> $
<br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAR CLAIMS-MADE
<br /> AGGREGATE $
<br /> DFD RETENTION $
<br /> WORKERS COMPENSATION PE
<br /> _
<br /> AND EMPLOYERS'LIABILITY YIN X I STA UTE I 21TH
<br /> BOFFICEANYPR IMEMB RIPARTNERIEXECUTIVE ❑ �1 h►� r) /� �I A G 01/15/2024 01/15/2025 E.L.EACH ACCIDENT 1 0
<br /> (Mandatory
<br /> NH)
<br /> N NIA V V L 't`'F`' 5 $ 00,000
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000.000
<br /> If yes,describ OF O E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> er
<br /> DESCRIPTION un DPl RATIONS below
<br /> C F'ailSafe Technology Errors 76SBMBC3ROR 07/05/2024 07/05/2025 Each Wrongful Act $1,000,000
<br /> or Omissions Liability Aggregate Limit $1,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required)
<br /> City of Santa Ana, officers, agents, employees, and volunteers are additional insured per Additional Insured: Owners,
<br /> Lessees, or Contractors; Scheduled Person or Organization Form SS4170 attached to this policy. Waiver of Subrogation
<br /> applies in favor of the Certificate Holder per the Business Liability Coverage Form SL 00 00, attached to this policy and the
<br /> Hired Auto and Non Owned Auto Endorsement SSO438 attached to this policy. Coverage is primary and noncontributory
<br /> per the Business Liability Coverage Form SL 00 00, attached to this policy. Notice of Cancellation will be provided in
<br /> accordance with Form SL9013 attached to this policy."
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Attn: Risk Management Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 20 Civic CenterPgLZ ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Santa Ana, 92701-4058 AUTHORIZED REPRESENTATIVE
<br /> Tu Tran �r1112n I
<br /> Nguyen 11A41 W
<br /> APPROVED -
<br /> e 1988-2016 ACORD CORPORATION. All rights reserved.
<br /> By To Tran Nguyen at 11.48 M D k,20,Z5,
<br /> __ am, Mar '� .. .�-:; RO name and logo are registered marks of ACORD
<br />
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