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CERTIFICATE OF LIABILITY INSURANCE
<br />F DATE (MM/DD/YYYY)4/11/2019
<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
<br />CONTACT
<br />NAME: Marie Swaney
<br />Dealey, Renton & Associates
<br />PHONE FAX
<br />790 E. Colorado Blvd, #460
<br />AIC No Ext: 626-844-3070 A/c No:
<br />ADODRES& mswaney@dealeyrenton.com
<br />Pasadena, CA 91101
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />Lic #0020739
<br />INSURERA: Travelers Casualty & Surety Co. America
<br />31194
<br />INSURED URBANCROS
<br />INSURERB: National Fire Insurance Co of Hartford
<br />20478
<br />Urban Crossroads, Inc.
<br />260 E Baker St, #200
<br />INsuRERc: Valley Forge Insurance Company
<br />20508
<br />INSURERD: Continental Insurance Company
<br />35289
<br />Costa Mesa, CA 92626
<br />INSURER E :
<br />949-606-1994
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:601036982 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 />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />C
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />6021297176
<br />11/1/2018
<br />11/1/2019
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE OCCUR
<br />PREMISES DAMAGE TO
<br />ccurrence
<br />PREMISES Ea occurrence)
<br />$ 1,000,000
<br />X
<br />MED EXP (Any one person)
<br />$ 10,000
<br />Contractual Liab
<br />X
<br />XCU Included
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />POLICY jRO-
<br />ECT LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />6020089431
<br />11/1/2018
<br />11/1/2019
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />D
<br />X
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />Y
<br />Y
<br />6020089476
<br />11/1/2018
<br />11/1/2019
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />AGGREGATE
<br />$ 2,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ n
<br />$
<br />g
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />Y
<br />6025002328
<br />11/1/2018
<br />11/1/2019
<br />X PER OTH-
<br />STATUTE ER
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />NIA
<br />E.L. DISEASE- EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE- POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Professional Liability
<br />105517955
<br />11/1/2018
<br />11/1/2019
<br />$1,000,000
<br />Per Claim
<br />$2,000,000
<br />Annual Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Umbrella policy is a follow form to its underlying Policies: General Liability/Auto Liability/Employers Liability. Attached are the Blanket Policy forms as required
<br />per written contract or agreement: GL Additional Insured Policy form #SB-146968-A (Ed. 01 /06), AUTO Additional Insured Policy form #CNA63359XX (Ed.
<br />04/12) and WC Waiver #G19160-B.
<br />RE: All operations of the named insured -- City of Santa Ana, its officers, employees, agents, and representatives are named as additional insured as respects
<br />general and auto liability as required per written contract or agreement. General Liability is Primary/Non-Contributory per policy form wording. Insurance
<br />coverage includes waiver of subrogation per the attached endorsement(s).
<br />CERTIFICATE HOLDER CANCELLATION 30 Day Notice given to Cert holder
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana, its officers, employees, agents, and
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />representatives
<br />Attn: Purchasing Division
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701
<br />ACORD 25 (2016/03)
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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