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Digitally signed by Francine R.
<br />Francine R. Villareal Villareal
<br />Date: 2021.07.14 09:25:47-07'00'
<br />GENEPUM-01 TKARUNA
<br />,d►coRO CERTIFICATE OF LIABILITY INSURANCE
<br />FDATE (MMIDDIYYYY)
<br />5/26/2021
<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 endorsement(s).
<br />PRODUCER License # 0757776
<br />CONTACT Sherri Ben -Nun
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (818) 257-7438 (A/C, No):
<br />HUB International Insurance Services Inc.
<br />16030 Ventura Blvd.
<br />Suite 500
<br />E-MAIL-ADDRESS: sherri.bennun@hubintemational.com
<br />Encino, CA 91436
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A : Travelers Property Casualty Company of America
<br />25674
<br />INSURED
<br />INSURER B: Aspen Specialty Insurance
<br />10717
<br />INSURER 7
<br />General Pump Company, Inc.
<br />INSURER D 7
<br />159 N. Acacia Street
<br />San Dimas, CA 91773
<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 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 />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />P-630-7K939062-TIL-21
<br />6/1/2021
<br />6/1/2022
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />100,000
<br />$
<br />MED EXP (Any oneperson)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY X 71 PEA LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />X
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />810-ON810047-21-43-G
<br />6/1/2021
<br />6/1/2022
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />CUP-1N325156-21-43
<br />6/1/2021
<br />6/1/2022
<br />AGGREGATE
<br />$ 4,000,000
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y/N
<br />ANY PROPRIETOR/ R/EXECUTIVE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />EXCLU
<br />(Mandatory in NH)
<br />N/A
<br />A
<br />UB-7K940269-21-43-G
<br />6/1/2021
<br />6/1/2022
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />B
<br />Pollution / Environm
<br />ERAHL9621
<br />2/5/2021
<br />2/5/2022
<br />Each Incident
<br />1,000,000
<br />B
<br />Pollution / Environm
<br />ERAHL9621
<br />2/5/2021
<br />2/5/2022
<br />Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Where required by written contract, the City of Santa Ana, its officers, employees, agents, and representatives are included as Additional Insured as respects
<br />operations of the Named Insured as their interest may appear per the attached #CG D2 46 04 19. Coverage is primary and non-contributory per Form #CGT100
<br />02 09, page 16, paragraph 4. 30 Days Cancellation except 10 Days for Non -Payment
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />Y
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL BE DELIVERED IN
<br />Risk Management Division, 4th Floor
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />IZisieManagzmRCYVED
<br />�
<br />BY.-
<br />REVIEWED &APPROVED BY.
<br />a
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<br />v�
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD C
<br />The ACORD name and logo are registered marks of ACORD
<br />Risk Management Analyst
<br />
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