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Digitally signed by Francine R.
<br />Francine R. Villareal Villareal
<br />Date: 2021.05.24 14:13:45-07'00'
<br />� �®
<br />ACERTIFICATE OF LIABILITY INSURANCE
<br />FT.—T.
<br />5/20/2021
<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 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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />NAME: Halides Callej as
<br />MOC Insurance Services
<br />/CONN. Ext: (415) 957-0600 FAC No: (915)957-0577
<br />,CNN.,
<br />E-MAIL hcallejas@mocins.com
<br />ADDRESS:
<br />License No. 0589960
<br />101 Montgomery St., Suite 800
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Massachusetts Bay Ins. Co.
<br />22306
<br />San Francisco CA 94104
<br />INSURED
<br />INSURER B: Allmerica Financial Benefit Co.
<br />41840
<br />INSURER C: Hanover Insurance Company
<br />22292
<br />Keyser Marston Associates, Inc.
<br />INSURERD:
<br />1299 4th Sreet Suite 408
<br />INSURER E
<br />INSURER F:
<br />San Rafael CA 94901
<br />COVERAGES CERTIFICATE NUMBER:GL-AUTO-UMB-E&O 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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/DDNYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />CLAIMS -MADE ❑X OCCUR
<br />DAMAED
<br />PREMISES Ea occurrence
<br />PREMISES (E. oc ",
<br />$ 500,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />X
<br />ZDFA49104906
<br />12/1/2020
<br />12/1/2021
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />❑XPRO
<br />JECT LOC
<br />PRODUCTS-COMP/OP AGG
<br />$POLICY Included
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />B
<br />ANYAUTO
<br />BODILY INJURY (Per accident)
<br />$
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />X
<br />AWFA490049
<br />12/1/2020
<br />12/1/2021
<br />X
<br />PROPERTY DAMAGE
<br />Per accident)$
<br />NON -OWNED
<br />AUTOS
<br />HIRED AUTOS MX
<br />X
<br />Uninsured motorist combined single
<br />$ 1,000,000
<br />Comp $500 Coll $500
<br />X
<br />UMBRELLA LAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />N
<br />AGGREGATE
<br />$ 4,000,000
<br />C
<br />EXCESS LABCLAIMS-MADE
<br />DED X RETENTION $ 0
<br />$
<br />X
<br />UHFA49117106
<br />12/1/2020
<br />12/1/2021
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />PER OTH-
<br />STATUTE OR
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$
<br />OFFICER/MEMBER EXCLUDED? F
<br />N /A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />C
<br />Professional Liability
<br />LHFD42616503
<br />12/1/2020
<br />12/1/2021
<br />Each Wrongful Act $1,000,000
<br />Retention $25, 000
<br />Retro Date: 11/11/1976
<br />Aggregate Limit $2, 000, 000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />City of Santa Ana, City of Santa Ana Acting as Successor Agency and/or Housing Authority of the City of
<br />Santa Ana, its officers, employees, agents, volunteers and representatives are Additional Insured with
<br />respects to the Insured's operations. This insurance is primary as respects the Entity, its officers,
<br />officials,employees, and volunteers. Any Insurance of self-insurance maintained by the Entity, its
<br />officers,officials,employees,or volunteers shall be excess of the Contractor's and shanll not contribute
<br />with it. 30 Day Notice of Cancellation/10 Day for nonpayment of premium.
<br />CERTIFICATE HOLDER
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE DE:
<br />THE EXPIRATION DATE THEREOF,
<br />ACCORDANCE WITH THE POLICY
<br />AUTHORIZED REPRESENTATIVE
<br />alidee Callejas/HCA
<br />Risk Management Dh islan
<br />REVIEWED & APPROVED BY.
<br />. c 4l.gq q
<br />Risk ManagementAnaly5t
<br />rwlid. La)If{rY
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />INS025 (201401)
<br />
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