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Francine <br />Digitally signed by <br />Francine R. Villareal <br />R. Villareal <br />Date: 2020.09.29 <br />11:03:00 -0TO0' <br />AFRO® CERTIFICATE OF LIABILITY INSURANCE <br />DAT9E( M jl2DDD20YYY) <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 <br />THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), <br />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. <br />A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsements . <br />PRODUCER <br />CONTACT <br />NAME: Yehuda Kaplan <br />ROSEWOOD RISK MGMT& INS SOLUTIONS <br />qIC NNa Ext: 323-8994081 alc No: <br />816-895-9169 <br />ADDREs, ka Ian rrmis.com <br />7162 Beverly Blvd, Ste 180 <br />INSURERS) AFFORDING COVERAGE <br />NAICA <br />Los Angeles, CA 90036 <br />INSURER A: PennStar Insurance Company <br />10673 <br />License#:0H38577 <br />INSURED <br />National Data and Surveying Services <br />INSURER B: US Fire Ins. Co. <br />21113 <br />INSURER c: StarStone National Insurance Co <br />25496 <br />INSURER D: OBE Insurance Co <br />39217 <br />1535 S La Cienega Blvd <br />INSURER E <br />INSURER F: Penn -America Insurance Company <br />32859 <br />Los Angeles, CA 90035 CA 90035 <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 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 <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />OFF <br />MMNDlYYYY <br />MMIDDIYPOLICY <br />POLICY YYY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />5 1000000 <br />CLAIM6Mo.DE FyI <br />OCCUR <br />DAMAGE TED <br />PREMSESOEa occurrence) <br />5 100000 <br />MED EY.P (Any one person) <br />5 5,000 <br />PERSONAL& Am INJURY <br />5 0 <br />A <br />Y <br />Y <br />CPVUC3S694, PAVC24555C <br />911712UZU <br />912112D21 <br />LIMIT APPLIES PER <br />GENERALAGGREGATE <br />5 2000000 <br />GEN'LAGGREGesTE <br />X <br />PRO <br />POLICY PRO- LOG <br />PRODUCTS-COMPIOPAGG <br />5 0 <br />Deductible <br />5 2,500 <br />OTHER: <br />AUTOMOBILE LIABILITY <br />EO BINEDairumat[ISINGLE LIMIT <br />5 1000000 <br />X ANY AUTO <br />BODILY INJURY (Par person) <br />5 <br />B <br />AIIT)EEDONLY .S1UT05ULED <br />Y <br />USF 133-748305-02 <br />911712UZU <br />911712921 <br />BODILY INJURY (Per accident) <br />5 <br />XHIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Per accident <br />5 <br />5 <br />UMBRELLA LA <br />X <br />OCCUR <br />EACH OCCURRENCE <br />5 5,000,000 <br />C <br />X <br />EXCESS LIA. <br />CLAIMS -MADE <br />Y <br />77763H2O7AL1 <br />911712UZU <br />912112021 <br />AGGREGATE <br />5 5,000,000 <br />DED X RETENTION$ 10000 <br />5 <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIA BILITY <br />ANY PROPRIETORIPARTHERIEXECUTIN E YIN <br />OFFICERWEMBER ExcwDEDI ❑ <br />NIA <br />Y <br />P0014-CE201653604C <br />911712020 <br />911712021 <br />X STATUT E ERH <br />EL. EA CH ACCIDENT <br />5 1000000 <br />E.L. DISEASE -Eo. EMPLOY EE <br />5 1000000 <br />I Mindat.,in NH) <br />If yes describe under <br />DESCRIPTION OF OPERATIONS bebm <br />E.L. DISEASE - POLICY LIMIT <br />5 1000000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional RemaMe Schedule, may be attached if more space is required) <br />City of Santa Ana its officers, employees, agents and representatives are provided <br />additional insured status on a primary and noncontributory basis as required by written <br />contract or agreement <br />A Waiver of Subrogation is in favor of the additional insured. <br />30 Days Notice of Cancellation. 10 Davis for Non Pavment of Premium. <br />City of Santa Ana <br />Risk Management Division 4th Floor <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <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 />rrRiiDI:T:T A1Ie7 T' ..I-ilff T.l <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />n <br />Risk ManagemadDMsian <br />REVIEWED&APPROV®BY: <br />P. mud <br />®' <br />®� <br />Risk Management Analyst <br />