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GOItI7 CERTIFICATE OF LIABILITY INSURANCE
<br />DATE I MMIDDNYYY,
<br />09122/2019
<br />THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HDLDER. 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 en ADDITIONAL INSURED, the pollcy(las) must have ADDITIONAL INSURED provisions or be ondorsod.
<br />If SVBROGATION IS WAIVED, Bubjectto the terms and conditions of the policy, certain policies may require an endoreemont. A statement on
<br />this certificate does not confer rights to tho certlflcata holder In IIev of such endorsoment(B),
<br />PRODUCER
<br />C NTAJennie CA rcla
<br />NAME:
<br />The Emplre Company
<br />PNCNE --
<br />550 North Park Center Drive
<br />rcAN�,txn. Arc Not;
<br />lgercie�emplro-da.com
<br />Suite 2.06
<br />ADDRESS:
<br />--"-- "-"
<br />_ I NSURER(81 AFFORDING COVERAGE
<br />NAICa
<br />Santa Ana CA 92705
<br />INSURER A: Ohio Security Insurance Company
<br />24082
<br />INSURED
<br />INSURER s; American Fire and Casually Insurance Company
<br />24066
<br />Transportation 8Indies Inc
<br />INSURER c I United States Llabllily Insurance Company
<br />26595
<br />2640 WolnUl AvO Ste L
<br />INSURER D;
<br />INSURER E:
<br />Tustin CA 92780
<br />1INSURER F;
<br />COVERAGES CERTIFICATE NUMBER; 2019-2020 Master REVISION NUMBER
<br />]'HIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
<br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT
<br />TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ILTR
<br />_
<br />TYPE OF INSURANCE
<br />ATI ll
<br />BCBR
<br />�
<br />POLICY NUMBER
<br />POUCYEFF
<br />MMI00%YYY
<br />MMIO C /YYYY1
<br />LIMITS
<br />MERCIAL GENERAL LIABILITY
<br />O OCCUR
<br />T
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />"MMADITCLAIMS-MADE
<br />RF Isf Ss w
<br />S 600,000
<br />MEO EIIP (Arty ups p0Rnn1
<br />S 16,000
<br />A
<br />BK859050934
<br />10101/2019
<br />1DID112020
<br />PERSONAL aAOV INJURY
<br />$ 1,000.000
<br />OEN',AOORCOATE LIMITAPPLIES PER:
<br />_ POUCY EJECT LOC
<br />GENERALAOGREOATE
<br />$ 2,000,000
<br />PRODUCTB-COMPIOPAGG
<br />S 2,000,000
<br />_
<br />OTHER:
<br />Expense Mod Factor 1
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />Ea .admo1aINGLE LIMIT
<br />E 1,000,000
<br />X
<br />ANYAUTO
<br />BODILY INJURY (Par Person)
<br />b
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />BAS60050934
<br />W/01/2019
<br />10/61/2020
<br />BODILY INJURY ((Pal e.W.tro
<br />$
<br />Per acd a
<br />Uninsured material
<br />$ 1,000,000
<br />X
<br />UMBRELLA LIAe
<br />OCCUR
<br />B"'
<br />EACH OCCURRENCE
<br />ffi 11000,000
<br />B
<br />EXCESS UAB
<br />cIAIMs-MADE
<br />USA59050934
<br />10/01/2019
<br />10/0112020
<br />AGGREGATE
<br />_
<br />a 1,000,000
<br />QED
<br />X REfF:NnON 9 1O,OOtl
<br />$
<br />__
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY
<br />ANY PROPRIETOPUPARTNERIEXECUTNB YIN
<br />OFFICERIMEMBER EXCLUOEDR
<br />(Mandatary In NEI
<br />II yes, dasedbe Under
<br />DESCRIPTION OF OPERATIONS LeIow
<br />N/A
<br />XWES9050934
<br />10/01 /2018 -
<br />—
<br />�10/Ot/2020
<br />"- "
<br />>PER OTH
<br />STP.TUTE ER
<br />E.L_EACH ACCIDENT
<br />$ 1,000;000
<br />E.L. OIGEASE-CA EMPLOYEE
<br />5 1,000,000
<br />EL. DISEASE POLICY LIMIT
<br />$ 1,W0,000
<br />_
<br />C
<br />ERRORS & OMISSIONS
<br />SPI022743H
<br />10/0112019
<br />1D/0112020
<br />LIMTT
<br />DEDUCTIBLE
<br />$1,000,000
<br />$1,D9D
<br />DESCRIPTION OF OPERATIONS LOCATIONS I vEHiCLEE (ACORD 101, Additlpnel Rpmpds Bahadal% may be allacdod It m.....ma la requlmdl
<br />no. Agreement to Provide Tmlf c Counting Services on an On -Call Basis pC
<br />Me CRY of Santa Ana, Its officers. employees, agents, volunteers and representatives are named is additional Insureds with pdm uyVncn-con9lbWO IEWED & APPR
<br />wording In respect to line general Ilabllly Coverage per forms GG50100413 alleched as required by written contract. By Fsk MANACIEMEM V
<br />nD
<br />O9
<br />CERTIFICATE HOLDER CANCELLATION
<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, Risk Management Dlvlsloll,
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />4th Floor
<br />AUTHORIZED REPRESENTATIVE
<br />11
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702
<br />01988.2016
<br />ACORD CORPORATION, All rights reserved.
<br />ACORD 25 (20%03) The ACORD name and logo are registered marks of ACORD
<br />EAL
<br />
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