|
HOWF GEP-4ta
<br />CERTIFICATE OF LIABpA1MQP@kNCE by An im-
<br />PRODUCER
<br />MG Skinner & Associates
<br />11030 Santa Monica Blvd., Suite 207
<br />Los Angeles, CA 90025
<br />EFLIMIZI
<br />- Mt. 112�i ii... �i i il� •
<br />INSURERA:rnnaueIjpnjA ins4FqpqqS�ompA I
<br />..................................................................... . ......... . . . . . . ........... ...... . . ....... ......... . . ... .. .... . ...... . . . ..........
<br />INSURED INSURER B: Ace American Ins Co 22667
<br />........................... . ...... . ..................................... . .... . ..................... - — — - - ----------
<br />Howroyd Wright Employment Agency Inc., dba Apple One _INSUR ER C ; ..... ..... ........... . ..................... .. . . ......... .............. . . . ........ . ... ...... . . . . . . . .
<br />P.O. Box 29048 INSURER D;
<br />Glendale, CA 91209 .. . . .................................. .. ...... .. ...... . . ........... . ......................... - - ----------- - - ------------ ........... -
<br />INSURER E:
<br />..... — --- --- . . . . . . . . ........................... . .. - ...... . . . . ...... . . ............................ . .—
<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 />-9 POLIC Y EXP
<br />INSR' TYPE OF INSURANCE ADDL LIBIR POLICY NUMBER LIMITS
<br />-LM.._ .._ -_
<br />A X 11 COMMERCIAL GENERAL LIABILITYOCCURRENCE-
<br />11 3,000,000
<br />EACH OCCURRENCE $
<br />. ....... .. ....... . . ... . ... . . ....
<br />DAMAGE TO RENTED 100,000
<br />CLAIMS -MADE F-K OCCUR x PHPK2397255 4/1/2022 4/112023 fflEMI&EC, tEa A-
<br />X Contractual Liab Mgp,EXR,Any w p 5,000
<br />..............
<br />PERSONAL ADV INJURY----__ 3,000,000
<br />----- - . ..........
<br />GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 3,000,000
<br />. ..... ........... . . . . . . . ..........
<br />F7 P 3,000,000
<br />x POLICYF7 56R(?T❑ LOG PRODUCTS - COMP/0 --- AGG,,; . ....... .... ........... . . . . . .......
<br />�OTHER
<br />.................... . . . . . . .............................. . _ . .......... . . . ..............
<br />A COMBINED SINGLE LIMIT 11000,000
<br />AUTOMOBILE LIABILITY Ma accrdqnt) _ — ------ ... .............. . . . ... .
<br />aim
<br />ANYAUTO PHPK2397255 4/1/2022 4/112023 BODILY I er
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS "BODILY INJURY (Per accident)�,
<br />TYPE OF IN
<br />COMMERCIAL GENERAL
<br />CLAIMS
<br />X NUTN6�V X, AUTOS
<br />8NffD R
<br />ONLY A .'gPAMAGE' $ .......... ....... . . . ..
<br />. . .........
<br />A X UMBRELLA LIAB OCCUR EACH OCCURRENCE 16,000,000,
<br />..................... 1
<br />EXCESS LIAR CLAIMS.MADE PHUB809384 41112022 411/2023 AGGREGATE 15,000,000
<br />............ .. . . . ... .. .. .. .
<br />10,000
<br />D $
<br />B jwoRKaRs COMPENSATION . . ..... X I PER OTH- . . . ......
<br />..9
<br />AND EMPLOYERS! LIABILITY STATUTE 111.3 . . ..... ............... .
<br />Y/N WLRC6892800A 4/112022 41112023 E.L. EACH ACCIDENT ANY PROPRIETOR/PARTNER/EXECUTIVE [_�] 11000,000
<br />OFFICERIMEMBER EXCLUDED? N/A . . . . . . ................................ . . . . .
<br />(Mandatory
<br />Mand tory in NH) 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $
<br />a r T! s describe under
<br />lfyes,
<br />e6Resc E.L. DISEASE -POLICY 11000,000
<br />DES low LIMIT $
<br />........... —_ _.. IPTIONOFOPERATI NSb
<br />• Crime (3rd Party) PHPK2397255 4/1/2022 1 4/1/2023 Occurrence/Aggregate 1 3,000,000
<br />• E&O/Prof. Liability PHPK2397255 4/1/2022 4/1/2023 Occurrence/Aggregate 3,000,000
<br />............... ---------
<br />DESCRIPTION OF OPERATIONS J LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Job ID 009600724003
<br />"Re: City of Santa Ana Agreement No. A-2018-146". The City of Santa Ana, officers, agents, employes and volunteers are named additi,opej.) gl, 'pri this
<br />policy pursuant to written contract, agreement, or memorandum of understanding. Primary and Non -Contributory coverage will apply. W146 Ede o ancellation
<br />under applicable policies- 30 days/ 10 days for non-payment of premium.
<br />............... . --- . .....
<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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701-4010 AUTHORIZED REPR TAM Risk Mazaganent ElMsirm
<br />REVIEWED & APPROVED BY.-
<br />... . .......... . . L.777:a . . . . .........
<br />ACORD 25 (2016/03) 0 1 ' 2015 ACORD A*fp AvvA4
<br />iw�
<br />The ACORD name and logo are registered marks of ACORQ___ ,r 1 3- Risk Management Specialist
<br />
|