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1-10WRGEN-01 ACCOUNTMANAGER
<br />CERTIFICATE OF LIABILITY INSURANCE DATE(MMIoorcvrv)
<br />5)12/2021
<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 TIME COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), 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
<br />NAME;
<br />MG Skinner & Associates PHONE FAX
<br />111030 Santa Monica Blvd., Suite 207 (Arc, No, eop (310) 478-5041 JA1C, No):(310) 47_9-8707
<br />Las Angeles, CA 90025 APONES&
<br />INSURER(S) AFFORDING COVERAGE NAIC d
<br />iNSURiERA!Philadelphia Insurance Companies__
<br />INSURED INSURERH:ACe Arnericarl Ins Co _ 22667
<br />Howroyd Wright Employment Agency Inc,., dba Apple One INSURER —
<br />P.O. Box 29048 INSURER0:
<br />Glendale, CA 9120E -- _.....,_
<br />INSURER E :
<br />INSURER F:
<br />COVERAGES —_�RTIFICATE NUMBERS EVISION NUMB€R'
<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 CONTRACTOR 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 />iN R A00L SUER POLICY EFF POLICY EXP -"—
<br />_— TYPEOFINSURANCE _-INSO sWp POLICY NUMBER [mEeIQD1YYYY1 fMMIDii1YY1[YI LIMITS
<br />A . — _ EACH X COMMERCIAL GENERAL LIASILITY 3,000,000
<br />.....� NCIE g
<br />__ CLAIMS MADE f X' OCCUR X PHPK2256316 4/112021 41112022 . DAMAGE 5 RENTLEa l ®nc;=1 —g 100,000
<br />X Contractuai Liab. 5 0()0
<br />....__ .. - MEO EXP,Anr oncerson, ;_ r
<br />E5C RIP ION OF OPERA NS 1 LOCA VEHICLES IACOR
<br />PERSONAL$ ApV INJURY-
<br />$
<br />3,000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER
<br />GENERALgGGREGATE
<br />$
<br />3,000,000
<br />POLICY PP% 1 ; LOG
<br />3,000,ii00
<br />-X L__._.1
<br />PRODUCTS -COMPIOPAGG
<br />-S
<br />A
<br />AUTOMOBILE LIABILITY
<br />((EaM9cIN�£D�SINGLE LIMIT
<br />$
<br />1,000,000
<br />X ANY AUTO
<br />PHPK2256316
<br />4i'112021 4/112022
<br />- aODILYINJURY Perperydnl
<br />g
<br />OLVNED SCHEDULED
<br />- —
<br />. 10S O NL Y Al Tn`OS
<br />BODILY INJURY acci_d_aml
<br />, s
<br />I pp yy
<br />X - AT- S ONLY -X A'UTOa �JNLY
<br />p�� a hGE
<br />A
<br />X UMBRELLA LIAB X OCCUR
<br />1J6gH OCCURRENCE
<br />$
<br />1510001000
<br />I
<br />EXCESSLIAe CLAIMSMADEPHUS762438
<br />41112021 4/1/2022
<br />AGGREGATE
<br />16,00,000
<br />_
<br />DEC, X RETENTION$ 10,000
<br />b
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABIIJTY
<br />X PER OTH-
<br />ER
<br />YIN
<br />ANY PROP°IETORlP.9RTNERIExECLTIVE
<br />FICE MEM9ER EXCr UOEU� NIA
<br />WLRC67316493
<br />411/2021 4/112022
<br />.._.5TATUTE `
<br />E L EACH ACC19ENT
<br />---
<br />$
<br />11000,000
<br />I
<br />i and$ am n N)
<br />_
<br />1,000,000,
<br />it yyeg, descnbe under
<br />DE5 OF OPERATIONS
<br />E.L DISEASE --FA EMPLOYEE_
<br />1,004 0 00
<br />._--
<br />'RIPTION
<br />,
<br />A
<br />Crime(3rdParty)
<br />PHSD1619067
<br />41112021 41l/2022
<br />OccurrencelAggregate
<br />3,040,000
<br />A
<br />o
<br />E&O1Prof. Liability
<br />r no TIONS
<br />PHPK2256316
<br />1
<br />41112021 4/1/2022
<br />OccurrencelAggregate
<br />3,000,000
<br />1 D 10 , Additional Kamarks Schedule, may be attached If more Space Is required)
<br />Job ID OOSS00724
<br />"Re: City of Santa Ana Agreement No, A-2018-146". The City of Santa Ana, officers, agents, employes and volunteers are named additional insured on this
<br />policy pursuant to written contract, agreement, or memorandum of understanding. Primary and Non -Contributory coverage will apply, Notice of Cancellation
<br />under applicable policies: 30 days/ 10 days for non-payment of premium.
<br />I
<br />CERTIFICATE HOLDER
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701-4010
<br />ACORD 25 (2016103)
<br />CANCEf_LATIt7N —�_-
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AU7HOR9ZE0 REPRESENTATI'7-
<br />%sk A/trngon [ D'ntdT
<br />"= EA--.-D 6 AVPPOvM Br -
<br />_ r) 1 s88.20 ACORD Ce 7eu r
<br />The ACORD name and logo are registered marks of ACORD R.k M"w9-t amid Aid,
<br />
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