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Francine R.
<br />Villareal
<br />CLEAR-1
<br />Digitally signed by
<br />Francine R. Villareal
<br />Date: 2021.04.21 17:10:34
<br />-07'00'
<br />P D: AR
<br />r'S I �s
<br />CERTIFICATE F LIABILITY INSURANCE
<br />SU CE
<br />DATE /02/2020
<br />1 uo2/2o20
<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 endorsements .
<br />PRODUCER 831-337-4661
<br />Clarion Pacific Insurance
<br />2035 N.. Pacific Ave.
<br />CMDMTACT Ariel Rittenhouse Williams
<br />PHONE 831-337-4661 IFAX 831-612-1810
<br />(A/C, No, Ext): (A/c, No):
<br />Santa Cruz, CA 95060
<br />Ryan Deane
<br />E-MAIL
<br />ADDRESS: arie pac-ris .com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Travelers Property Casualty Co
<br />25674
<br />MSURED
<br />earsource Financial Consulting
<br />Terry Madsen
<br />7960 Soquel Dr. ste: B363
<br />INSURER B : Nationwide Mutual Insurance Co
<br />23787
<br />Philadelphia Indemnity
<br />INSURER C : p
<br />1$058
<br />Aptos,-CA-95003 __._ _._. .._. ._.. ._ ...... __.
<br />-INSURER.D:
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VViTH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />DDL
<br />211%L
<br />UBR
<br />ma_POLICY
<br />NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />CP 3029102473
<br />12/09/2020
<br />12/09/2021
<br />EACH OCCURRENCE
<br />S 2,000,000
<br />AGE TO RENTED
<br />PR DAMMI Ea occurrence
<br />300,000
<br />$
<br />MED EXP (Any oneperson)_$
<br />5,000
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY J f LOC
<br />GENERAL AGGREGATE
<br />S 4,000,000
<br />GEN'L
<br />X
<br />PRODUCTS- COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />$ 2,000,000
<br />BODILY INJURY Perperson)
<br />S
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLYNAUTOS
<br />X
<br />ACP 3029102473
<br />12/09/2020
<br />12/09/2021
<br />BODILY INJURY Per accident
<br />-""
<br />$
<br />X
<br />AUTOS ONLY AUUTOS ONLY
<br />PRO, a.dentDAMAGE
<br />_
<br />.S
<br />S
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />S
<br />AGGREGATE
<br />$
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED I RETENTION $
<br />S
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
<br />FICER/M W, EXCLUDED?
<br />andatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N / A
<br />UB-8M759710-21-42-G
<br />01/01t2021
<br />01/01/2022
<br />X PER OTH-
<br />T TUT
<br />E.L. EACH ACCIDENT
<br />1,Oo0,000
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />S 1,000'000
<br />EL DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />Professional Liab
<br />PHSD1584535
<br />12/09/2020
<br />12/09/2021
<br />Occurence
<br />2,000,000
<br />Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: Citywide Indirect Cost Allocation Plan and Internal Service Funds Cost
<br />Allocation Methodology. City of Santa Ana, its officers, employees, agents,
<br />and representatives are Additional Insureds with respect to General
<br />Liability and Auto Liability per the attached endorsements or as required by
<br />written contract. Insurance is Primary and Non -Contributory. 30 day notice*
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division,
<br />4th Floor AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />ACORD 25 (2016/03) ©1988-2015 ACORD COR �Ra_ RiskMarlagmedUlMsian
<br />The ACORD name and logo are registered marks of ACORD } % z REVIEWED & APPROVED BY. -
<br />Risk Management Analyst
<br />
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