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<br />A� " CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />9/28/2021
<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
<br />CONTACT
<br />NAME: Dana Webers
<br />SilverStone Group LLC, a HUB International company
<br />PHONE FAX
<br />11516 Miracle Hills Drive
<br />A/C No Ext : 402-964-5787 A/C, No):
<br />E-MSuite
<br />ADDRESS: dana.wiebers@hubinternational.com
<br />100
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />Omaha NE 68154
<br />INSURERA: Liberty Insurance Corporation
<br />42404
<br />INSURED DMSFACI-02
<br />INSURERB: AIG Specialty Insurance Company
<br />26883
<br />DMS Facility Services LLC
<br />DMS Facility Services, Inc.
<br />INSURERC: Liberty Mutual Fire Insurance Co
<br />23035
<br />INSURERD: First Liberty Insurance Corp.
<br />33588
<br />1040 Arroyo Drive
<br />South Pasadena CA 91030-2908
<br />INSURERE: Travelers Property Casualty Co of America
<br />25674
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:638742899 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 />POLICYNUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />C
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />TB2-691-458727-081
<br />10/1/2021
<br />10/1/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE � OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence)$
<br />100,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRO -
<br />POLICY � ECT1:1 LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />D
<br />AUTOMOBILE
<br />LIABILITY
<br />AS6-691-458727-071
<br />10/1/2021
<br />10/1/2022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<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 />E
<br />X
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />CUP-6S829988-21-NF
<br />10/1/2021
<br />10/1/2022
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ 1 n nnn
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />WA7-69D458727-061
<br />10/1/2021
<br />10/1/2022
<br />X PER OTH-
<br />STATUTEI ER
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED? FN]
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />B
<br />Contractors Pollution
<br />CP016083633
<br />10/1/2021
<br />10/1/2022
<br />Each Loss
<br />1,000,000
<br />Liability
<br />Aggregate
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Re: Landscape Maintenance (District 1 and 4) for the RFP No. 15-112 City of Santa Ana, its officers, employees, agents and representatives are included as
<br />Additional insureds as respects General Liability, including completed operations, as required by written contract. Primary/Non-Contributory wording is included
<br />as respects General Liability, as required by written contract. Waiver of Subrogation with respects to Workers Compensation applies in favor of the City of Santa
<br />Ana, its officers, employees, agents and representatives as required by written contract. 30 days' Notice of Cancellation provided with respects to General
<br />Liability, Auto, & Workers Compensation as required by written contract. (Except for 10 days for non-payment of premium)
<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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Risk MmrgmweDiftm
<br />Santa Ana CA 92701 REmEu,En6MmovEDBy
<br />@ 1988-2015 ACORD C( - "'S"'wanegemen
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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