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Client#: 1086878 INTERCON35 ACORD,., CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYYI 11107/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certifcate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME USI Insurance Services, LLC PHONE 800 873-8500 I FAX P.O. Box 7050 tAIC NoiEae.. -... _.. Nol: E-MAIL Englewood, CO 80155 ADDRESS: --- --- --' - ------ -- — - -- INSURER(S)AFFORDING COVERAGE NAIC# 800873-8500 INSURER A:TIYeInnPrupedyCae.ceerA,nero 25674 INSURED XL 3eadseY l,nuranwC.."ry INSURERB t Consulting Group Inc 37$$$ 25682 T 1— In&rnnlry C.," M CT P.O. Box 18330 INSURER C: _. P.O.InteBox Boulder, CO 80308 INSURER D: INSURER E: INSURER F : UUVCIXAbtJ UER I IFIOA I E NUMBER: UCMIe1nM MUuoeo. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. OL INSR - AOWVP -POLICY EFF POLICY EXP I --- - -- - -- LTR TYPE OF INSURANCE I SR WYO POLICY NUMBER MMIDDIYYYY (MMIDDIYYYYI LIMITS A GENERAL LIABILITY X X 6806H441235 _ 11/14/201910/Ot/202 EACH OCC_UR_R_E_N_C_E $1,000000CLAIMS-MADE ICOMMERCIAL X ODLUR_ �_._.. �RR��iii;FEsTEaEonetiEerenw)$1000000 .. 41 O,000 - MED EXP (My FEE dersonl PERSONAL SAOVINJURY S1,000,000 GENV AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s2,000,000 X 1_7 POLICY COT LOC PRODUCTS $2,000,000 S OTHER. �I AUTOMOBILELMSILITY X XBAOJ093233 COMBINED 10101/2020 1,000,000e X PNY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY (Per acodenl) S X HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY RTYDAM P40PEAGE EP,,r aciudent) - S i 8 A X _ UMBRELLA LIAR X OCCUR X X CUP2F178249 11/14/2019 10/01/2020 EACHOCCURRENCE_ s4000O00 EXCESS LIAR CLAIMS -MADE. I _ A,GREGATE_ 54000000 S QED X RETENTION SO _ A WORKERS COMPENSATION X ,UB8J034006 11114/2019 10/01/2020 X PER OT14 LI AND EMPLOYERS' ABILITY YIN - T T MY PROPRIETOILPARTNERIEXECUTIVEn OFFICER/MEMBER EXCLUDED' NIA E-_ EACH ACCIDENT 51 QOO OOO _ .. 0 -_—. (Mandalory In NH) EL DISEASE - EA EMPLOYEE $1,000000 Iryas, desnibe under - -- DESCRIPTIONOFOPERATIONS below EL DISEASE -POLICY LIMIT $1,000,000 11114/2019 11/14/2020 $2,000,000 per claim B Professional Liab X DPR9951576 Pollution Liab $5,000,000 anal aggr. Claims Made DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. AddlBonal Remarks Schedule, may be aNaeked If more space Ie required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and owner are included as Automatic Additional Insured's for ongoing and completed operations under General Liability; Designated Insured under Automobile Liability; and Additional Insureds under Umbrella I Excess Liability but only with respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. (See Attached Descriptions) O KISK VI NA EMENT LAVl ORIHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, A F 252019 Santa Ana, CA 92702 AUTIIORIZ OREPRESENTATIVE 4/\/kA A M. LAMBE T o-n_, ED 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) 1 Of 2 The ACORD name and logo are registered marks of ACORD #S27092524IM27088729 ADKZP