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AC R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDIYYYY)
<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 endorsement(s).
<br /> PRODUCER CONTACT NAME: paychex Insurance Agency Inc
<br /> PAYCHEX INSURANCE AGENCY, INC. PHaNNa Ext: 877-266-6850 FAX No; 585-389-7426
<br /> LAIC,225 KENNETH DRIVE E-MAIL ce is@paychex.com
<br /> ROCHESTfER, NY 14623 ADDRESS:
<br /> INSURERS AFFORDING COVERAGE NAIL#
<br /> INSURER A:Sentinel Insurance Company, LTD
<br /> INSURED INSURERB: Sequoia Insurance Company
<br /> PROUDCITY
<br /> DBA PROUDCITY INSURER C: Hartford Fire Insurance Company
<br /> 2219 DAMUTH ST
<br /> OAKLAND,CA 94602 INSURER D:
<br /> INSURER E
<br /> INSURER F
<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 TYPE OF INSURANCE ADOL SUER POLICY EFF POLICY EXP
<br /> LTR IN SD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE ® OCCUR PREMISES Eaaccurrence $ 1,000,000
<br /> © �-+ MED EXP(Any one person) $ 10,000
<br /> ` ,I 76SBMBC3ROR 07/05/2024 07/05/2025 PERSONAL&ADV INJ U RY $ 1,000,000
<br /> GFN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY❑JECTPRO ❑ LOC PRODUCTS-COMPIOPAGG $ 2,000,000
<br /> x PRO-
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 o00'Q00
<br /> Ea accident
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> A- OWNED SCHEDULED AUTOS ONLY AUTOS V 76S B M BC3 RO R 07/05/2024 07/05/2025 BODILY INJURY(Per accident))Pid $
<br /> .
<br /> X HIRED X NON-OWNED PROPERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> $
<br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y 1 N XSTATUTE ER
<br /> ANYPRO MEMBRlPARTNERIEXECUT€VE S1NC 1528366 E.L.EACH ACCIDENT $ 1,000,000
<br /> B (Mandatory
<br /> in N REXCLUDED? NIA 01/15/2025 01/15/2026
<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 /> C FailSafe Technology Errors or 76SBMBC3ROR 07/05/2024 07/05/2025 Each Wrongful Act $1,000,000
<br /> Omissions Liability
<br /> Aggregate Limit $1,000,000
<br /> DESCRIPTION OF OPERATIONS f LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule.,may be attached if more space is requlredl
<br /> City of Santa Ana,officers,agents,employees,and volunteers are additional insured per Additional Insured:Owners,Lessees,or Contractors;Scheduled Person or
<br /> Organization Form SS4170 attached to this policy.Waiver of Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SL 00
<br /> 00,attached to this policy and the Hired Auto and Non Owned Auto Endorsement SSO438 attached to this policy.Coverage is primary and noncontributory per the
<br /> Business Liability Coverage Form SL 00 00,attached to this policy. Notice of Cancellation wilt be provided in accordance with Form SL9013 attached to this policy."
<br /> Digitally signed by
<br /> Tu Tra n
<br /> Tute 2 a Nguyen APPROVED
<br /> Nguyen 114:39:455-0T00'S A
<br /> CERTIFICATE HOLDER CANCELLATION 8y Tu Tran Nguyen=at 2:'39-pm,Mar 25i 2025
<br /> City of Santa Ana
<br /> Attention: Informational Technology SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> 20 Civic Center Plaza,M-42 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Santa Area,CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> AUTHORIZED REPRESENTATIVE
<br /> ©1988-2016 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
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