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<br />DATE (MM/DD/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />9/25/2019
<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 />CONTACT
<br />PRODUCER
<br />Risk Strategies Company
<br />Emily Elsbree
<br />NAME:
<br />FAX
<br />PHONE
<br />700 Airport Boulevard, Suite 300
<br />(650) 762-0425(650) 762-0490
<br />(A/C, No):
<br />(A/C, No, Ext):
<br />Burlingame, CA 94010
<br />E-MAIL
<br />eelsbree@risk-strategies.com
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGENAIC #
<br />INSURER A :Sentinel Ins. Co.11000
<br />INSURED
<br />INSURER B :Hartford Casualty Insurance Company29424
<br />Circlepoint
<br />INSURER C :AXIS Insurance Company37273
<br />200 Webster Street, Suite 200
<br />INSURER D :Underwriters at Lloyds London15642
<br />Oakland CA 94607
<br />INSURER E :
<br />INSURER F :
<br />COVERAGESCERTIFICATE NUMBER:REVISION NUMBER:
<br />51368250
<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 />ADDLSUBR
<br />INSRPOLICY EFFPOLICY EXP
<br />TYPE OF INSURANCELIMITS
<br />POLICY NUMBER
<br />LTR(MM/DD/YYYY)(MM/DD/YYYY)
<br />INSDWVD
<br />COMMERCIAL GENERAL LIABILITY
<br />A57SBARI355410/1/201910/1/2020
<br />EACH OCCURRENCE$
<br />2,000,000
<br />DAMAGE TO RENTED
<br />CLAIMS-MADEOCCUR$
<br />1,000,000
<br />PREMISES (Ea occurrence)
<br />MED EXP (Any one person)$
<br />Contractual Liability10,000
<br />PERSONAL & ADV INJURY$
<br />2,000,000
<br />4,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$
<br />PRO-
<br />POLICYLOCPRODUCTS - COMP/OP AGG$
<br />4,000,000
<br />JECT
<br />$
<br />OTHER:
<br />COMBINED SINGLE LIMIT
<br />AUTOMOBILE LIABILITY$
<br />A57SBARI355410/1/201910/1/2020
<br />2,000,000
<br />(Ea accident)
<br />ANY AUTO
<br />BODILY INJURY (Per person)$
<br />OWNEDSCHEDULED
<br />BODILY INJURY (Per accident)$
<br />AUTOS ONLYAUTOS
<br />NON-OWNED
<br />HIREDPROPERTY DAMAGE
<br />$
<br />(Per accident)
<br />AUTOS ONLYAUTOS ONLY
<br />$
<br />UMBRELLA LIAB
<br />A57SBARI355410/1/201910/1/2020
<br />EACH OCCURRENCE$
<br />3,000,000
<br />OCCUR
<br />EXCESS LIAB
<br />CLAIMS-MADEAGGREGATE$
<br />3,000,000
<br />10,000
<br />$
<br />DEDRETENTION$
<br />PEROTH-
<br />WORKERS COMPENSATION
<br />B57WECGH283510/1/201910/1/2020
<br />STATUTEER
<br />AND EMPLOYERS' LIABILITY
<br />Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT$
<br />1,000,000
<br />N / A
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYEE$
<br />1,000,000
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT$
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />CProfessional LiabilityDP00418001201910/1/201910/1/2020Per Claim $2,000,000
<br />Retroactive Date 1: 11/01/1987Annual Aggregate $2,000,000
<br />Retroactive Date 2: 05/14/2015Pollution Liability Included
<br />DCyber LiabilityASH19H0091967/16/20197/16/2020Per Claim $2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Ref: project number 4.4797
<br />The City of Santa Ana, it's officers, employees, agents, and representative are included as additional per form SS00080405
<br />where primary insurance and waiver of subrogation also apply with respects to General Liability
<br />CERTIFICATE HOLDERCANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CITY OF SANTA ANA
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 CIVIC CENTER PLAZA
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />SANTA ANA CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />Mike Christian
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
<br />51368250 | 19/20 GL-AU-UMB-WC-XS-E&O: Per Project | Emily Elsbree | 9/25/2019 2:48:50 PM (PDT) | Page 1 of 8
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