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8/29/2019 5:58:50 PM 178504 Servando Varela Dba Xv Solutions Certificate or Insurance Page 0 az) A �® `o�ao CERTIFICATE OF LIABILITY INSURANCE DAT/29/2DIYYYY) 8/29/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT ORDEDINSUR BETWEEN THE IS R(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the Policy(ies) must have ADDITIONAL INSURED or be provisions endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer ri hts [o the certificate holder in lieu of such endorsements . PRODUCER CONTACT 000 Loi Techlnsurance NAME: PHONE : (800 868 7020FAX > UUC No'- 877-826-9067 "s 7echlnsurance ADDRESS: 30 N. LaSalle, 25th Floor, Chicago, IL 60602 INSURE S AFFORDING COVERAGE NAIC9 INSURER A: Sentinel Insurance Company, Limited 11000 INSURED Servando Varela Dba Xv Solutions INSURER B: PO BOX 28373, Santa Ana, CA, 92799 INSURER C: INSURER D INSURER E : INSURER F —""" THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED REVISION NUMBER: TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE OTHER DOCUMENT WITH RESPECT TO WHICH THIS POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY INSR ADDL BR PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER M /M POLICY EFF POUCY EXP LIMITS ✓ COMMERCIAL GENERAL LIABILITY EACH OCCURRW 82•DOD•D00 CLAIMS -MADE ❑✓ OCCUR PREMISES Ea omLsrsnoe $ 1,000,000 A MED EXP (Any one Pelson) $ 10,000 Yes 46SBMUN0237 SGO/2019 BYJ012020 PERSONAL aADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- GENERAL AGGREGATE $4,DOO,OOD JECT LOC PRODUCTS - COMP/OP AGG $ZOO DOD OTHER: 8 AUTOMOBILE LIABILITY C MBI INGL LIMIT Ea awdenl $ 2,DOD,000 ANY AUTO ALL ED BODILY INJURY (Per person) 3 AUTOSSCHED Yes Yes 46SBMUNU37 6l M019 WQI2M0 BODILY INJURY (Per accldeM) $ `Y NONA HIRED AUTOS ✓ AUTOS PROPERTY DAMAGE $ Till ecccl t $ UMBRELLA LIAR OCCUR E%CESS LIAR EACH OCCURRENCE $ AGGREGATE $ CLAIMS -MADE DEC RETEMION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIABIUTY YIN STATUTE ER ANVCERNEETORIEXCLUDRIEXECUTIVE ❑NIq NIA E.L. EACH ACCIDENT $ (Mantlatory In NN) (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If Yes, tlecrtibe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ I DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule, may beattached amore apace is required) Please see the attached "Additional Remarks Schedule" form for additional details and remarks REVIEWED & APPROVED By tkMANAQEMENT DIVISION 09�21 Gig CERTIFICATE HOLDFR _...__... _. _ _ _ City of Santa Ana 20 Civic Center Plaza, Santa Ana, CA 92701 Attn: Risk Management Division, 4th Floor aI'e--............, SHOULD ANY OF THE ABOVE DESCRIBEb POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2014 All rights 1 fins el vmu name ano logo are registered marks of ACORD