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l u6 DATE (MM/DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE <br />8/22/2019 <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 CONTACT <br />NAM <br />Arthur J. Gallagher & Co. QNONE Fax <br />Insurance Brokers of CA Inc. License #0726293 twq,. 949-349-9800 c No: 949-349-9900 <br />E-MAIL <br />18201 Von Karman Ave Suite 200 ADDRESS• <br />Irvine CA 92612 INSURERM AFFORDING COVERAGE NAIC # <br />INSURER A: Nationwide Mutual Insurance Company USE 23787 <br />INSURED SUPEPRO-04 INSURERB: Accredited Surety and Casualty Co, Inc 26379 <br />Superior Property Services, Inc. <br />9129 Perkins Street INSURERC: <br />Pico Rivera CA 90660 INSURERD: <br />INSURER E : <br />INSURER F : <br />-^\ A^+ O d111a1112C0.4RGO9RORnA RFVISIrIN NIIMRFR, <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 SM UR TYPE OF INSURANCE ima AO POLICY NUMBER POLICY tl MOD 1r E7[A LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />ACP3018842080 <br />6/22/2019 <br />6/22/2020 <br />EACH OCCURRENCE <br />$1,000,000 <br />CLAIMS -MADE Fx_] OCCUR <br />DAMAGE TO RENTED <br />PREMISES tEa oc=renrel <br />$ 50,000 <br />MED EXP (Any one person) <br />$ 1.000 <br />_ <br />PERSONAL & ADV INJURY <br />$1,000,00o <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS -COMP/OPAGG <br />$2.000,000 <br />%( POLICY [K PEC LOC <br />$ <br />OTHER: <br />A <br />AUTOMOBILE LIABILITY <br />ACP 3018842080 <br />6/22/2019 <br />6/22/2020 <br />OM81Nq]S1N U I <br />Es accede t <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />BODILY INJURY (Per accident) <br />$ <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />IX HIRED NON -OWNED <br />X AUTOS ONLY X AUTOS ONLY <br />TY DAMAGE <br />TPer mddent) <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I I RETENTION $ <br />$ <br />g <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETORIPARTNER/EXECUTIVE Y /�N <br />1ATCA16001830 <br />6/22/2019 <br />6/22/2020 <br />X OTERH <br />T TE <br />E.L. EACH ACCIDENT <br />$ 1,000.000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />OFFICER/MEMBEREXCLUDED7 <br />(Mandatory In NH) <br />N / A <br />E.L, DISEASE - POLICY LIMIT <br />$ 1.000 000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <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, Its officers, employees, agents, volunteers and representatives are additional <br />Insureds when you have agreed, in a written contract or written agreement, onty with respects to the General Liability, Umbrella and Business Auto as per <br />business liability coverage forms CG 20 33 04 13, CO 20 37 04 13 and CA 88 10 01 13. Primary and non-contributory wording is Included as per form CG 20 01 <br />04 13. A waiver of subro aVon is Included regarding the General Liability as per farm CG 24 04 05 09. <br />Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation. REVIEWED & APPROVE <br />By Risk MANACCMENT Elivisk <br />nrr.Ylrlr Arc "^3 ncm r A hir`CI I ATInAI n <br />i <br />SHOULD ANY OF THE ABOVE DESCRIBED P j3Dbt��� <br />91LE <br />THE EXPIRATION DATE THEREOF, NO I 1[`C'j <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Risk Management Division <br />Au DRIIEDREPRESENTATIVE <br />20 Civic Center Plaza, 4th floor <br />Santa Ana CA 92702 <br />C47 "I `JtS tS-2UlO MI.VKU I,VKYVKMI IVrV. MII F1911L, 1tl5C1 VUU. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />