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CERTIFICATE OF LIABILITY INSURANCE <br />9/1312019 <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 endorsenu s). <br />PRODUCER OACT <br />NAME: <br />Weaver Bros. Ins. Associates PHONE F <br />4550 Montgomery Ave., #300N • 301-986-4400 _.. Dime 301-986.4422 <br />Bethesda MD 20814 A n aast <br />MSDRED ORGAN-4 <br />Organizational Quality Assoc. <br />Peggy McDonald <br />2802 Mooring Way SE <br />Southport NC 28461 <br />INSURER A: THE HARTFORD <br />INSURER B: United States Liability Insura <br />INSURER c: <br />INSURER D: <br />INSURER E: <br />COVFRA(%FS CFRTIFICATF NIIMRFR• 111%U7A19 O9VI4InN1 NIIMRFO• <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 />ILTp <br />TYPE OFINSURANCE <br />POUCYNUMBER <br />ELF' <br />M LICYEXP <br />UNITS <br />A <br />X <br />COI4MERCIALGENERALUABILRY <br />CLAIMSMADE [fl OCCUR <br />Y <br />42SBABW3781 <br />121/2019 <br />1/21/2020 <br />EACH OCCURRENCE <br />sL000,000 <br />_OAMAGET0ER. RT9_N@j_ <br />1EOEXP(AnyorreJaT22)_ <br />$10.000 <br />_ <br />PERSONAL SADV INJURY <br />$1.000.000 <br />AGGREGATE LIMIT APPLIES PER <br />GENERAI.AGGREGATE <br />$2.00%000_ <br />GEN'L <br />POLICY ERT 171 LOG <br />PRODUCTS-COMP/OPAGG <br />$2.000.000 <br />_ <br />s <br />OTHER: <br />A <br />AUTOMOBILELUIBNITY <br />Y <br />42SBABW3781 <br />1212019 <br />1Y212020 <br />COMBINED SPHRUE.LIMIT <br />$1.000,000 <br />ANY AUTO <br />BODILY INJURY(Per me.) <br />3 <br />OWNED SCHEDULED <br />AUTOSOIJLY AUTOS <br />BODILY INJURY (Perawtlen0 <br />$ <br />X <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />_a0n11 _ <br />3 <br />s <br />A <br />X <br />UMBRELLA LIB <br />X <br />OCCUR <br />4238ABWG781 <br />1/21/2019 <br />1/21/2020 <br />EACH OCCURRENCE <br />32,000.000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />AGGREGATE. <br />32,000,000 <br />DED X RETENTION 3 <br />v <br />s <br />A <br />ANDEMPLOYERTUABILTY YIN <br />ANYPROPRIETORIPARTNEWEXECUTIVE <br />OFFICERMEMBEREXCLUOED7 <br />NIA <br />42WECAD0Z3B <br />3/192019 <br />3/19(Z020 <br />EL EACH ACCIDENT <br />31,000.000 <br />E.L.OISEASE-EAEMPLOYE <br />31.000000 <br />(Mandalory In HIM) <br />If yyea, desuibe ender <br />QESCRIPTIONOFOPERATIONSbebw <br />E.L.DISEASE-POLICYUMM <br />..- <br />$1,000.000 <br />e <br />PROFESSIONAL UAB <br />SP 1011433M <br />7/11/2019 <br />1/192020 <br />EACH CLAIM UMIT <br />1,000.D00 <br />I <br />1 <br />AGGREGATE UNIT <br />DEDUCTIBLE <br />3,000.000 <br />1,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES iACORD 101. Addillonal Rema&e Schedule, my be aNazhad-d more apace 6 reReired) <br />Re: Anaheim/Santa Ana UASI Agreement <br />If required by mitten contract, City of Santa Ana its officers, employees, agents, volunteers and representativesis an additional insured under the general <br />liability and automobile liability policies. Coverage is primary and non-contributory. A 30 day notice of cancellation applies <br />REVIEWED & APPROVED <br />BE <br />32019 InTHEULD EXANY OFPIRATIONH DATE DESCRIBED <br />NOTIICEI ES WILL CBECELLED DELIVEREDON <br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. <br />Risk Management Divis <br />20 Civic Center Plaza 4thRUACINE R. VILLAREAL AMUTHOG�/UVREPRESENTATIV/E Santa Ana CA 92701C.- <br />01988-2015 ACORD CORPORATION. All rights reserve <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />