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GOVEREV-01 KOLOWSKI
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<br />'`# t 7►° CERTIFICATE OF LIABILITY INSURANCE
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<br />bA112912O
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
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<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 />co ACT Daniel R. Gunter
<br />PRODUCER
<br />Thompson Flanagan Executive Liability Group AHONN ,ear. {312 239-2890 FAx
<br />1AIC N.)1(311)263-1551
<br />W. Jackson Blvd. 5th Floor )
<br />626 ..
<br />Chicago, IL 60661 e' o I dgunter thompsonfilanagan.com
<br />INSURERISI AFFORDING COVERAGE NAIC #
<br />INSURER A: The Continental Insurance ComDanv 35269
<br />INSURED INSURER B: American Casualty Company of Reading, Pennsylvania 20427 ,
<br />Government Revenue Solutions Holdings LLC INSURER C:RSUI Indemnity_22314
<br />d/b/a MuniServices, LLC
<br />7625 Palm Ave., Suite 106 INSURER D: Axis Insurance Com an 37273 .-
<br />Fresno, CA 93711 INSURER E: -
<br />iNSURER F
<br />rnvCIOArOCc rFRTlnir.ATF NIIMRER• REVISION NIIMRF_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 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 />INSRTYPE
<br />OF INSURANCE
<br />men SUER POLICY NUMBER POLICYEFF POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE 1'000'000
<br />Cr IMS -MADE ® OCCUR
<br />X 6043362567 1/2412019 1/2412020
<br />DAMAGE TO RENTED
<br />p EMI E $ 1,000,000
<br />MEDEXP An pna arson s 15,000
<br />&ADV INJURY 1'000'000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY El JET E LOG
<br />_PERSONAL
<br />GENERALAGGREGATE $ 2,090,DOO
<br />PRODUCTS- COME PAGG @ 2'000'000
<br />OTHER'
<br />B
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT j,ggg,gg0
<br />ANY AUTO
<br />6043362570 1/24/2019 1/24/2020
<br />BODILY INJURY Per erecn
<br />OWNED SCHEDULED
<br />AUTOSONLY AUTON pNNEEpo
<br />AUTOS ONLY X AUTOS ONNLV
<br />BpOpDILY INJURY Per acc dent) „$
<br />)PER DAVAIF
<br />A
<br />X UMBRELLA LIAB
<br />X OCCUR
<br />EACH OCCURRENCE 10,000,000
<br />AGGREGATE 10,000'000
<br />EXCESS LIPS
<br />CLAIMS-MADE
<br />6043362584 112412019 1/24/2020
<br />111
<br />DED I X I RETENTION $ 18,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETOR/PARTNEWEXECUTIVE ❑
<br />pFFlCER/h1E;M9 R EXCLUDED?
<br />{Mandatory rn )
<br />6043362536 1/24/2019 1/24/2020
<br />NIA
<br />seSTATUT 07H -
<br />1,000,000
<br />E.L. EACH ACCIDENT $ _ _
<br />E.L. DISEASE -EA EMPLOYE, 1,DDO,000
<br />If eadeaTdbeunder
<br />-SC IPoF OPERATIONS
<br />L DISEASE -POLiCYLIMIL 1,0OO,ODO
<br />C
<br />rofessiona Liabili
<br />LCY774107 1/24/2019 1/24/2020
<br />Limit 5,000,000
<br />D
<br />Directors & Officers
<br />MCN62051010112019 1/24/2019 1/24/2020
<br />Limit 1,000,000
<br />DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES (ACORD 101, AddiOonai Remarks Schedule, may be attached if mase space is requ lred)
<br />Per the cancellation wording listed on this form, the policy provisions include at least 30 days' notice of cancellation except for non-payment of premium.
<br />The City of Santa Ana, its agents, officers, servants and employees are named as additional insureds under the G Rare ,Liability otic with respect to the
<br />operations and work performed by the named insured as required by contract. rd
<br />e, ^
<br />CERTIFICATE HOLDER CANCELT O
<br />ACORD 25 (2016103) O 1986-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<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 />City of Santa Ana
<br />Attm Finance Director
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />lSanta Ana, CA 92702-1ARR
<br />ACORD 25 (2016103) O 1986-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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