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ACCDOI CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDIYYYY) <br />91/23/2019 <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 <br />NAMENT Klmberaly Kelley <br />: <br />Insurance Solutions <br />PHONEr <br />AIC No E.U, (949) 348-7400 <br />(AIC Nol' <br />License i/0746539 <br />ADDRESS: KImK@ins-s01U11on5.com <br />33302 Valle Rd, Suite 200 <br />� <br />INSURER(S) AFFORDING COVERAGE- <br />NAICY <br />San Juan Capistrano CA 92675 <br />INSURERA : 01110 Security Ins, CO. �- <br />24082 <br />INSURED <br />^ <br />INSURER e: American Fire and Casualty Company <br />24066 <br />VAyL <br />LCV ��P <br />Professional Sports Field Maintenance, Inc pJ <br />INSURERC: Stale Comp Ins Fund <br />36076 <br />29466 Ridge Rd �- o{0�9 <br />INSURER D : <br />(�1� <br />)cF —pE Oty— VI�3 <br />_ <br />INSURERS: <br />San Juan Capistrano CA 92675 <br />1 INSURERF: <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 />IUm <br />TYPE OF INSURANCE <br />INSO <br />POUCYNUMBER <br />MMA)DPrYW <br />MMIDDNYYY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE l OCCUR <br />EACHOCCURRENCE <br />_ <br />S 1,DO0,000 <br />FRE,ISES a...ncm <br />s 500,000 <br />MED EXP(Any one personi <br />$ 15,000 <br />A <br />SKS59328473 <br />11/01/2018 <br />11)01/2019 <br />PERSONAL A AOV INJURY <br />a 1,000,000 <br />E LIMIT APPLIES PER: <br />POLICY ❑PRO- ❑ <br />JECT tOC <br />GENERALAGGREGATE <br />g 2,000,000 <br />GEN'LAGGREGAI <br />X <br />PRODUCTS -COMPeOP AGO <br />S 2,000,000 <br />Package Modification <br />g <br />OTI IER: <br />AUTOMOBILE <br />LIABILITY <br />ANYAUTO <br />`XZ N DSINGLEUMIT <br />Ea e 1 <br />g <br />BODILY INJURY (Per person) <br />3 <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON OWNED <br />AUTOS ONLY AUTOS ONLY <br />BODILY INJURY (Per accident) <br />S <br />PRO DAMA E <br />pordooment <br />g <br />$ <br />B <br />1X <br />UMBRELLA LIAR <br />EXCESSUAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />USA59320473 <br />11/01/2018 <br />11/0112019 <br />EACH OCCURRENCE <br />3 2,000,000 <br />AGGREGATE <br />g 2,000,000 <br />OEO <br />I X1 RETENTION 5 0 <br />g <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOWPARTNER/EXECUTIVE <br />OFFICERIMEMSER EXCLUDED? <br />(Mandatory in NH) <br />II yea, describe under <br />DESCRIPTION OF OPERATIONS below <br />MIA <br />9242771.2018 <br />i0/30/2018 <br />10/30/201g <br />XPTA UTE ERH <br />E.L EACH ACCIDENT <br />g 1,000,000 <br />E.L. DISEASE -EA EMPLOYEE <br />g 1,000,000 <br />E.L. DISEASE, POLICY LIMIT <br />S 11000,000 <br />, <br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 10f, Additional Remarks SeRedule, may Its aaectmd if more epaca is required) � <br />The City of Santa Ana, its olfcers, employees, agents, and representative are included as additional insured per the attached endo^r}se pin0 <br />^� <br />CJ <br />V <br />City of Santa Ana <br />20 Civic Center Plaza <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 />AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92701% <br />01988.2013 ACORD CORPORATInid all drshse feaa„fed <br />ACORD 25 (2018/03) The ACORD name and logo are registered marks of ACORD <br />