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UP III YC <br />,4coR0 CERTIFICATE OF LIABILITY INSURANCE DATE (MIN/DOM YYH <br />IkI 1211712019 <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 be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, Certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder In lieu of such endorsements . <br />PRODUCER ICONTACTJune Samaria <br />INSURED <br />Ins Agcy <br />6033 W. Century Blvd. 5th Fir <br />Los Angeles, CA 90045 <br />INSURER(3) AFFORDING COVERAGE <br />INSURER A: Sentinel Insurance Company <br />INSURERS: Federal Insurance Company _ <br />INSURER c: Aspen Specialty Insurance <br />CnVFRACFS r1FRTIFICATF NI IILIRFR- RFVISION NUNIII <br />686-299.1010 <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 />INSLTRi <br />LT <br />TYPE OF INSURANCE <br />3L9fl <br />POLICY NUMBER <br />MO DOS MMLOD CY E <br />users <br />GENERAL UN ILRY <br />EACH OCCURRENCE <br />$ 2,000,00 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />x <br />2SBAAK0318 12/14/2019 12/14/2020 <br />rTOA <br />PREMISES Ea occurrence <br />$ 1,000,00 <br />CLAIMSMAOE OCCUR <br />MED EXP (My one pawn) <br />$ 1 D,00 <br />PERSONAL$ ADV INJURY <br />$ 2,000,000 <br />GENEMLAGGRE_GATE _$ 4.000.00 <br />PRODUCTS-COMMOPAGG S 4.000,00 <br />BEN'LAGGRE�GATE UMMAPPLIES PER. <br />j F- <br />S <br />X POLICY : PART <br />AUTOMOBILE <br />LIASILRY COMBINED SINGLE LIMIT I <br />S 2,000,00 <br />(EaacddaM) <br />ANY AUTO BODILY INJURY (Par Person) $ <br />�, <br />B <br />ALL OWNED AUTOS 9001LY IN11RY (Per ar<ad.0 S <br />SCHEDULED AUTOS . PROPERTY DAMAGE$ <br />A X <br />HIRED AUTOS 72SBAAK0318 12I14/2019 12114/2020 (PER ACCIDENT) <br />A <br />NON OWNED AUTOS 72SBAAK0318 12114/2019 12114/2020 _ $ <br />.X <br />_ <br />$ <br />X UMBRELLA Like LX OCCUR EACH OCCURRENCE $ 4,000,00 <br />EXCESS LIAR CLAIMS VALE AGGREGATE S 4,000,00 <br />p -i— -- 72SBAAK0318 12114/2019 12/14/2020.- --_ <br />DEDUCTIBLE $ <br />X1 RETENTION S 10,000 $ <br />'WORKERS COMPENSATION WC STATU- OT4 <br />X:TORY LIMITS E0. <br />AND EMPLOYERS LLUMUTY <br />B ANY PROPRIETORIPARMERIEY.ECUTNE Y� N A 7175-05-95 04/01/2019 04/0112020 E.L. EACH ACCIDENT <br />EXCLUDED'! <br />S t,000rD0 <br />S 1,000,00 <br />OEFICERIMEMSER <br />(M.Watory In NH) E.L. DISEASE EA EMPLOYEE <br />1,000,00 <br />Il yea, desalbounder <br />DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT$ <br />C <br />Professional Llab. LRA9AF818 12/1012019 12110/20201,Per Claim 6,00 <br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLE5 (Attach ACORD 10I Mdldon.I Remark. Schedule. It more apace la rpuired) <br />Certificate Bolder is named as an Additional Insured in regards to attached <br />General Liability Form SS 00 08, per written contract or agreement. <br />CITYSAA <br />L Jx� SHOULD ANY OF THE ABOVE DESCRIBED POUCHES BE CANCELLED BEFORE <br />City of Santa Ana RFVILD lY APPROVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza By Rik ANngeMFNr Divisio <br />P.O. BDIX 1988 AUTNORMED REPRESENTATIVE <br />Santa Ana, CA 92702 B 2 g 2020 <br />rsn 4onR_DnnA eCnlxn CORPORATION. All rlRhts reserved. <br />ACORD 25 (2009109) Ae AIVCORD I rUi Inv a, me and log or =d"I <br />hgare registered marks of ACORD <br />