|
Digitally signed by Francine F.
<br />Francine R. Villareal Villareal
<br />Daremmoa zs 13'. 15'. as 0700
<br />ACORO® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE IMMIDDIVVVV)
<br />12/17/2020
<br />8/14/2020
<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 INSURERS), 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 LOCkon Insurance Brokers. LLC
<br />CONTACT
<br />NAME:
<br />777 S. Figueroa Street, 52nd F1.
<br />PHONE FAX
<br />Ali N.,Stan AIC No:
<br />CA LICCnsc#OF]5767
<br />Los Angeles CA 90017
<br />ADDRESS:
<br />(2 13) 689-0065
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Crum & Fo1'stelSpecialty Insurance Co
<br />44520
<br />INSURED Rln Con Consultants, Inc.
<br />INSURER B: Hartford Fire Insurance COm any
<br />19682
<br />INSURER C : Starstone National Insurance Company
<br />25496
<br />1462718 180 N. AsliwoodAve.
<br />UCntul'a CA 93003
<br />INSURER D:
<br />INSURER E
<br />INSURER F :
<br />COVERAGES RINC001 CERTIFICATE NUMBER: 16059509 REVISION NUMBER: XXXXXXX
<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 rypE OF INSURANCE ADDLSUBR POLICYEFF POLICYEXP
<br />LTR INSD WVD POLICY NUMBER MMIDDIYVYV MMIDDIYVYV LIMITS
<br />A
<br />XY
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />PPK-125280
<br />12/17;201R
<br />12;172
<br />EACH OCCURRENCE
<br />$ 3,000.000
<br />CLAIMS -MADE I OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 100,000
<br />X
<br />MEDEXPAny are person)
<br />$ 10,000
<br />SIR:$50,000
<br />•
<br />P&I
<br />PERSONAL I ADV INJURY
<br />$ 3000.000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />POLICY F— PRO- F- LOC
<br />JECT
<br />PRODUCTS -COMPIOPAGG
<br />$ 4,000,000
<br />OTHER:
<br />$
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />y
<br />72UIINCB52s8
<br />2'1/2020
<br />2/1/2021
<br />CO MB INED SINGLE LIMIT
<br />Ee eoomant
<br />$ 1,000,000
<br />BODILY INJURY person)
<br />$ XXX
<br />XXXX
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident
<br />$ XXXXXXX
<br />IX
<br />X
<br />HIRED .{ NOWOWNEDPROPERTY
<br />AUTOS ONLY AUTOS ONLY
<br />DAMAGE
<br />Per accitlent
<br />$XXXXXXX
<br />$XXXXXXX
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />N
<br />N
<br />FFX-114134
<br />12/17/2019
<br />12i172(1
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />X
<br />EXCESS IIICLAIMS-MADE
<br />AGGREGATE
<br />$ 5,000,000
<br />DED X RETENTION $ 10,000
<br />$ XXXXXxx
<br />G
<br />AND EMPLOYERS' LIABILITY WORKERS COMPENSATION
<br />ANY PROPRIETORIPARTHERIEXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatary in NH)
<br />NIA
<br />Y
<br />T10200329
<br />2/1/2020
<br />2/1 2021
<br />PER
<br />X STATUTE OIRH
<br />E. L EACH ACCIDENT
<br />E.L DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />$ 1,000,000
<br />f yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />I
<br />I
<br />I
<br />EL. DISEASEPOLICYLIMIT
<br />$ 1,000.000
<br />A
<br />Cmtlm ors Pollution Tibia
<br />N
<br />N
<br />EPK-125280
<br />12/1732018,
<br />123172020
<br />Limit: $3,00(1'S4,000.000
<br />e&O Lint, -Claims Made
<br />Limit: $3,00(1'S4,000.000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />THISCERTIFICATE SUPERSEDES ALL PRE VIOI;SLY ISSUED CERTIFICATES FUR THIS HOLDER -APPLIC ABLE TO THB CARRIERS LISTED AND THE PULICti TERNI(S) REFERENCED.
<br />The City ASanta Ana orad Cmcenruny D,velopmcnt Ae racy and their effie o ,mplov,cs, ag,nts rmd volmt,cts are ora Additional ht,us4 to the ustorat provided by the policy longing,
<br />orendorsement issued in, diono Yd by the m,uraace career. Waiver of S111ho imlapplie, per attached eradtaonwat(s)nr policy language. Hlsarmmepmlided to Astifinnal In sured(,)
<br />is primary and raon-torahibutury as per the atNehed endeteca t or policy Ia rgurg Egnd o, policy fallow, General Linbilits, Anto Liability and Ensploy,rs Liability form. Notice of
<br />C ancellaNnn applies per the applicable policy language m'endoneal
<br />16059509
<br />City of Santa Ana
<br />Risk Management Divison
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana CA 92701
<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
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />REST Mstr8.gelllerdDiuisinn
<br />REmEWEDIAPPROVEDBV:
<br />'� Risk Management Analyst
<br />
|