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7 ® Francine R. °�e'a�,,;,
<br />A� o CERTIFICATE OF LIABILITY INSURANCE Villareal
<br />-,,,,PATE (MM/DD/YYYY)
<br />06/02/2021
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER LICENSE NO. 0637431
<br />CONTACT PATRICK MCRAE
<br />NAME:
<br />PATRICK MCRAE INSURANCE SERVICES
<br />AICNN Ext: (714) 779-6999 AIC No: (714) 779-6903
<br />E-MAIL ADDRESS: cerq
<br />tre uest mcraeinsurance.insure
<br />1265 N. MANASSERO ST. SUITE 303
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />ANAHEIM HILLS, CA 92807
<br />INSURERA: NAVIGATORS SPECIALTY INSURANCE CO.
<br />36056
<br />INSURED
<br />INSURERB: INSURANCE COMPANY OF THE WEST
<br />27847
<br />INSURERC: INTEGON NATIONAL INSURANCE COMPANY
<br />29742
<br />CROSSTOWN ELECTRICAL & DATA, INC.
<br />INSURERD: ATLANTIC SPECIALTY INSURANCE COMPAN
<br />27154
<br />5454 DIAZ STREET
<br />IRWINDALE CA 91706
<br />INSURERE: GREAT AMERICAN INSURANCE CO.
<br />16691
<br />INSURERF:
<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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WV D
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />X
<br />X
<br />LA20CGLZ04TP71C
<br />09/03/2020
<br />09/03/2021
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE L OCCUR
<br />XCU
<br />DEDUCTIBLE $5,000 PER
<br />OCCURENCE
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 100 000
<br />X
<br />MED EXP (Any one person)
<br />$ 5,000
<br />X
<br />OCP
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRO -
<br />POLICY � ECT1:1 LOC
<br />PRODUCTS- COMP/OP AGG
<br />$ 2,000,000
<br />EBL
<br />$ 1,000,000
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />2005675448
<br />11/05/2020
<br />11/05/2021
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$ -
<br />ANY AUTO
<br />ALL OWNED X SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$ -
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$ -
<br />X NON -OWNED
<br />HIRED AUTOS AUTOS
<br />E
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />TUE 2572052 03
<br />06/03/2021
<br />09/03/2022
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />UNDERLYING LIMITS:
<br />GL; AL; EL POLICIES
<br />X
<br />AGGREGATE
<br />$ 10,000,000
<br />X
<br />DED RETENTION$ 0
<br />_
<br />$ _
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY IN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y�
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />x
<br />WVE 5030354-06
<br />06/03/2021
<br />06/03/2022
<br />X SPER
<br />TATUTE EERH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DPROPERTY
<br />& CONTRACTORS
<br />EQUIPMENT
<br />710039414
<br />$1,000 DEDUCTIBLE
<br />COV. INCL. THEFT
<br />05/10/2021
<br />05/10/2022
<br />rw ,q
<br />$, 4, 000L...d BPP Premises
<br />a5etl BPP
<br />$'-'N00 B....
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />THE CITY OF SANTA ANA RISK MANAGEMENT DIVISION, ALONG WITH THEIR DIRECTORS, OFFICERS, AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED
<br />WITH RESPECTS TO THE ABOVE MENTIONED POLICIES PER ATTACHED ENDORSEMENT(S). COVERAGE IS PRIMARY & NON-CONTRIBUTORY AS REQUIRED BY
<br />WRITTEN CONTRACT, PER ATTACHED ENDORSEMENT FORMS. WAIVER OF SUBROGATION APPLIES, IF REQUIRED BY WRITTEN CONTRACT.
<br />* SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, A 30 DAY WRITTEN NOTICE WILL BE ISSUED.
<br />RE: MASTER AGREEMENT #A-2017-172 / AGREEMENT EXTENSION# A-2017-172-01/ CTWN JOB NUMBER: 3196
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITY OF SANTA ANA
<br />RISK MANAGEMENT DIVISION
<br />20 CIVIC CENTER PLAZA, 4TH FLOOR
<br />SANTA ANA, CA 92701
<br />SHOULD ANY OF THE ABOVE DE!
<br />THE EXPIRATION DATE THEP
<br />ACCORDANCE WITH THE POLICY
<br />AUTHORIZED REPRESENTATIVE
<br />F Risk Mziag aitDhislon
<br />_iIL x
<br />REVIEWED & APPROVED BY:
<br />®' Risk Management Analyst
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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