|
COMM LEG-01 CERTT3
<br /> ,d►coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 9/4/2025
<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 License#OC32169 CONTACT
<br /> NAME:
<br /> Rancho Mesa Insurance Services,Inc. PHONE FAX
<br /> 2355 Northside Drive Suite 200 (A/C,No,Ext):(619)937-0164 (A/C,No):
<br /> San Diego,CA 92108 E-MAIL
<br /> DD RIESS:
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA:Great American Insurance 16691
<br /> INSURED INSURER B:Service American Indemnity Company 39152
<br /> Community Legal Aid SoCal INSURER C:Travelers Casualty And Surety Company Of America 19038
<br /> 2101 North Tustin Avenue INSURER 7
<br /> Santa Ana,CA 92705
<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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MM/DD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR PACF3986700 9/1/2025 9/1/2026 DAMAGE TO RENTED 100,000
<br /> X X PREMISES Ea occurrence $
<br /> MED EXP(Any oneperson) $ 25,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY PRO X� LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> ANY AUTO PACF3986700 9/1/2025 9/1/2026 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000
<br /> EXCESS LIAB CLAIMS-MADE UMBF39868000 9/1/2025 9/1/2026 AGGREGATE $ 3,000,000
<br /> DED X RETENTION$ 10,000 $
<br /> B WORKERS COMPENSATION X PER STATUTE E ERR
<br /> AND EMPLOYERS'LIABILITY
<br /> Y/N SATIS0340105 9/1/2025 9/1/2026 1,000,000
<br /> ANY PROPRIETOR/EXCLUDED?
<br /> R/EXECUTIVE ❑ E.L.EACH ACCIDENT $
<br /> OF EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A Abuse&Molestation PACF3986700 9/1/2025 9/1/2026 Agg$21VI/Occ$1M Ded 0
<br /> C Cyber Security 106970101 9/1/2025 9/1/2026 Aggregate$3M, Ded 10,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> RE:A-2020-03-06.
<br /> CITY OF SANTA ANA,OFFICERS,AGENTS,EMPLOYEES,AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSURED WITH REGARDS TO THE GENERAL
<br /> LIABILITY PER THE ATTACHED FORMS.PRIMARY AND NON-CONTRIBUTORY WORDING APPLIES WITH REGARDS TO THE GENERAL LIABILITY PER
<br /> ATTACHED FORMS.WAIVER OF SUBROGATION APPLIES WITH REGARDS TO THE GENERAL LIABILITY PER ATTACHED FORMS.(p)
<br /> Tu Tran Dg l y signed by uTranNguy n APPROVED
<br /> Nguyen Date:2025.09.10
<br /> 15:37:54-moo' By Tu Tran Nguyen at 3:37 pm, Sep 10, 2025
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> CITY OF SANTA ANA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> ATTN: EXECUTIVE DIRECTOR,COMMUNITY DEVELOPMENT
<br /> 20 CIVIC CENTER PLAZA, M-25
<br /> SANTA ANA,CA 92701 AUTHORIZED REPRESENTATIVE
<br /> _-A
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
|