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<br />.4� o CERTIFICATE OF LIABILITY INSURANCE OATE(MM,On,
<br />nnnndon
<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 pol)cy(tes) 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 endorsements).
<br />PRODUCER
<br />Commercial Insurers - Lakewood
<br />Alkire Street
<br />CO 80228
<br />INSURED 4— 0-o ici — Oso
<br />Greenielay LLC
<br />1021 E. South Boulder Road Suite N
<br />Louisville, CO 80027
<br />CONTACT
<br />NAME:
<br />PHONE
<br />(Ac, No, Eat): (303) 9873373
<br />(Arc,No):(303) 969-9120
<br />EMAIL john.ossian@dcinsurers.com
<br />_ INSURERIS) AFFORDING COVERAGE
<br />NAICN
<br />INSURER A: The Hartford
<br />29424
<br />INSURER B : Pinnacol Assurance
<br />41190
<br />INSURER C :
<br />INSURER D :
<br />INSURER E :
<br />COVERAGES CERTIFICATE NUMRER- REVisinN wlmtarR•
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO 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
<br />THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE
<br />TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR ADOL SUBR POLICY EFF POLICY EXP LIMITS_
<br />LTH TYPEOFINSURANCE POLICY NUMBER
<br />A X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $
<br />2,000,000
<br />CLAIMS -MADE : X OCCUR X X 34SBAIR6876 51112019 5I1/2020 DAMAGERENTED
<br />ENTE e,tce)
<br />100,000
<br />$
<br />MEDEXPCAnyonepersum E
<br />10,000
<br />PERSONAL&ADV INJURY $
<br />2,000,000
<br />GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $
<br />4,000,000
<br />_ X POLICY. 7. QT LOC PRODUCTS COMPIOP AGG S
<br />4,000,000
<br />OTHER _ E
<br />A AUTOMOBILE LIABILITY COMBINEOSINGLELIMIT
<br />(Ea amdenU E
<br />1,000,000
<br />X ANY AUTO X X 34UECJJ1390 511/2019 5/1/2020 BODILY INJURY (Per permn) $
<br />OWNED SCHEDULED
<br />SCC�HEpDDUwLryEEDp
<br />AUTOS ONLY BODILY INJURY Ira, ac mmid $
<br />AUTOS Per pnrm.mTY )AMAGE
<br />_ ONLY _AUTOBONLV $
<br />A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $
<br />1,000,000
<br />EXCESS LIAB CLAIMS MADE X 34SBAIR6876 511/2019 5/112020
<br />AGGREGATE $
<br />DED X RETENTION$ 10,000 Gen Aggregate
<br />1,000,000
<br />$
<br />B PER X
<br />EMPLOY COMPENSATION
<br />S
<br />ANWORKERS
<br />LIABILIITY STATUTE ER
<br />YIN
<br />ANY PROPRIETORIPARTNERffXECUTIVE - X 4019301 5/112019 5/1/2020 EL EACH ACCIDENT $
<br />1,000,000
<br />WHCER/MBMBER EXCLUDED? N/A
<br />andatory in NH) EL DISEASE - EA EMPLOYEE $
<br />1,000,000
<br />If yes, das�ube under
<br />DESCRIPTION OF OPERATIONS bebw E L DISEASE � POLICY LIMIT $
<br />1,000,000
<br />• Business PP 34SBAIR6876 5/1/2019 511/2020 Ded 500
<br />32,200
<br />A Business Auto ded 34UECJJ1390 5/1/2019 6/1/2020 comp 500 & toll. 600
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS, VEHICLES IACORO 101, Additional Remarks Schedule, may ba attached If more apace Is required)
<br />City of Santa Ana, California and its officers, officals, employees and agents are named as additional Insured on the General liability (SS00080405)on Primary
<br />and non-contributory basis (SS60080405) and commercial auto (HA99160312) and Umbrella policies, when required by written contract. Waiver of subrogation
<br />on the General liability(SS00080405), commercial auto (HA99160312), and workers compensation policies, when required by written contract. 30 day
<br />cancellation notice applies (IH03130611). excess policy to follow form.
<br />Rev`eNedb`l \�
<br />City of Santa Ana, CA
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />SHOULD ANY OF
<br />THE EXPIRATI6
<br />REPRESENTATIVE
<br />5 BE CANCELLED BEFORE
<br />WILL BE DELIVERED IN
<br />ACORD 25 (2016/03)
<br />©1988.2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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