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WESTCOM-16
<br />CSRINIVA 1
<br />DATErvrrl
<br />10121202/2019
<br />ACO/?U' CERTIFICATE OF LIABILITY INSURANCE
<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 hostler is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />H 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 endomemen s .
<br />PRODUCER License # 0757776
<br />c CT ,Jordan BarUeson
<br />HUB International Insurance Services Inc.
<br />3390 University Avenue, Suite 300
<br />Riverside, CA 92501
<br />PHONE FAX
<br />A/C, No, Exec (877) 825-2681 M. No :(951) 231-2572
<br />. CaLCPU Hubintemational.com
<br />INSURE 3 AFFORDING COVERAGE NAIC0
<br />INSURERA:SentlnelInsurance Company, Ltd.
<br />11DOO
<br />INSURED
<br />INSURER a: Trumbull Insurance Company
<br />27120
<br />INSURER C: Axis Insurance Company
<br />37273
<br />Westbound Communications, Inc.
<br />INSURER D:
<br />625 The City Drive, Suite 480
<br />Orange, CA 92868
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CFRTIFICATF NIIMRFR• RF1114111M NI IMRFR•
<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 />UISR
<br />TYPE OF INSURANCE
<br />ACOL
<br />X
<br />SUBR
<br />POLICY NUMBER
<br />POLICY
<br />EFF
<br />POLICY UP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE �X OCCUR
<br />723BAia4627
<br />516/2019
<br />5/612020
<br />EACH OCCURRENCE
<br />2,000,000
<br />DAMAGE TO RENTED
<br />1,000,000
<br />MED EXP (my one
<br />10,000
<br />PERSONAL S ADV INJURY
<br />1 2,000,000
<br />GENL AGGR TE LIMIT APPUES PER:
<br />X POLICY jpCT 7 LOC
<br />AGGREGATE
<br />4,000,00O
<br />-GENERAL
<br />PRODUCTS - COMPIOP ADS
<br />4,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILEUAMLITY
<br />COMBINED SINGLE LIMIT
<br />S 2,000,000
<br />BODILY INJURY Per
<br />$
<br />ANY AUTO
<br />R OSONLYNAICITHOSULED
<br />2SBA1B4627
<br />SM2019
<br />SMI2020
<br />BODILY INJURY Per acadenl
<br />3
<br />X
<br />PROP b AMAGE
<br />Por
<br />$
<br />�������� N y�N�p
<br />AUTOS ONLY AOo ONLY
<br />8
<br />A
<br />X
<br />UMBRELLAA9 LI
<br />EXCESS LUB
<br />X
<br />OCCUR
<br />CINMS4AADE
<br />72SBAIB4627
<br />516/2019
<br />5/6/2020
<br />EACH OCCURRENCE
<br />S 2,000,000
<br />AGGREGATE
<br />2.000,000
<br />DED X RETENTIDNf 10,000
<br />B
<br />W�Rs co Ano AND
<br />S' IRUTY YIN
<br />AApW PROPRIETggOEER/PARTNERF ECUTNE
<br />(MFanCetoryln NX) EXCLUDED? Y
<br />If yss scr1w under
<br />DESCRIOePTION OF OPERATIONS below
<br />NIA
<br />X
<br />72WECLR3783
<br />9128/2019
<br />9/28/2020
<br />X PER OT14
<br />EL EACH ACCIDENT
<br />1,000,000
<br />E.L DISEASE- EA EMPLOYE
<br />1,000,00Q
<br />E.L. DISEASE - POLICY LIMIT
<br />3 1,000,000
<br />C
<br />Professional Liab
<br />POOIOOO17481601
<br />9/25/2019
<br />9/2512020
<br />Per Claim
<br />3,000,000
<br />C
<br />Retention: $10,000
<br />P00100017481501
<br />9/2612019
<br />912512020
<br />Aggregate
<br />3,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Rmanits ScMduls, may bs attached a more space Is rxluired
<br />Revised 10/212019 - This certificate rescinds and supersedes any and all prior certificates Issued on behalf of the Named Insured.
<br />RE: C-6-1626
<br />City of Santa Ana, its officers, directors, employees and agents and Orange County Transportation Authority are Additional Insured with regard to General
<br />Liability and Hired and Nonrowned auto liability when required by written contract per the attached endorsement SS0008 04105 (pgs. 10-14 of 24). Primary 8
<br />Non -Contributory wording and Waiver of Subrogation coverages apply to the General Liability policy when required by written contract per the attached
<br />endorsement SS0008 04105 (pgs. 16-17 of 24). Waiver of Subrogation applies to Workers Compensation when required by written contract per the attached
<br />endorsement WC9903038 08100.
<br />RREED & APPROVED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Y RIS ANACIEMENf DIVISION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Divisl 5flJN
<br />20 Civic Center Plaza, dt 1 61020
<br />Santa Ana, CA 92702 AUTHORIZED
<br />RURESENTATIVE
<br />SAMANTHA M, LAMBERT
<br />ACORD 25 (2016103) 01988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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