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<br />NAIC #
<br />203032028112777
<br />12/18/2020
<br />1,000,0001,000,00010,0001,000,0002,000,0002,000,00010,000,0001,000,00050,000,00050,000,0001,000,0001,000,0001,000,000
<br />DATE (MM/DD/YYYY)
<br />(651) 484-1602
<br />$$$$$$$$$$$$$$$$$$
<br />LIMITS
<br />OTH-ER
<br />FAX(A/C, No):
<br />PERSTATUTE
<br />Combined TotalAggregate
<br />EACH OCCURRENCEDAMAGE TO RENTEDPREMISES (Ea occurrence)MED EXP (Any one person)PERSONAL & ADV INJURYGENERAL AGGREGATEPRODUCTS - COMP/OP AGGCOMBINED SINGLE LIMIT(Ea accident)BODILY INJURY
<br /> (Per person)BODILY INJURY (Per accident)PROPERTY DAMAGE(Per accident)EACH OCCURRENCEAGGREGATEE.L. EACH ACCIDENTE.L. DISEASE - EA EMPLOYEEE.L. DISEASE - POLICY LIMIT
<br />REVISION NUMBER:
<br />POLICY EXP
<br />12/31/202112/31/202112/31/202112/31/2021
<br />(MM/DD/YYYY)
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />INSURER(S) AFFORDING COVERAGE
<br />(800) 497-3424
<br />Great Northern Insurance CompanyFederal Insurance CompanyChubb Indemnity Insurance Company
<br />Rose Tonnrose.tonn@northriskpartners.com
<br />POLICY EFF
<br />12/31/202012/31/202012/31/202012/31/2020
<br />(MM/DD/YYYY)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.
<br />CONTACTNAME:PHONE(A/C, No, Ext):E-MAILADDRESS:INSURER A :INSURER B :INSURER C :INSURER D :INSURER E :INSURER F :CANCELLATION AUTHORIZED REPRESENTATIVE
<br />20/21 CERT #3
<br />55164-001655402-143692701
<br />POLICY NUMBER
<br />CA
<br />MNMN
<br />35983569735728257988074771749276
<br />WVD
<br />The ACORD name and logo are registered marks of ACORD
<br />SUBR
<br />N / A
<br />INSD
<br />ADDL
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />N
<br />Y / N
<br />CERTIFICATE NUMBER:
<br />LOC
<br />0
<br />OCCUROCCURCLAIMS-MADE
<br />$
<br />SCHEDULEDAUTOSNON-OWNEDAUTOS ONLY
<br />PRO-JECT
<br />RETENTION
<br />TYPE OF INSURANCE
<br />CliftonLarsonAllen LLPLarsonAllen LLP, Clifton Gunderson LLP220 South 6th Street, Suite 300MinneapolisCity of Santa AnaRisk Management Division20 Civic Center Plaza, 4th FlSanta Ana
<br />
<br />CLAIMS-MADE
<br />COMMERCIAL GENERAL LIABILITYPOLICYOTHER:ANY AUTOOWNEDAUTOS ONLYHIREDAUTOS ONLYUMBRELLA LIABEXCESS LIABDED
<br />GEN'L AGGREGATE LIMIT APPLIES PER:AUTOMOBILE LIABILITY
<br />WORKERS COMPENSATIONAND EMPLOYERS' LIABILITYANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?(Mandatory in NH)If yes, describe underDESCRIPTION OF OPERATIONS below
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER
<br /> THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE
<br /> CERTIFICATE HOLDER.IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.If SUBROGATION IS WAIVED, subject
<br /> to the terms and conditions of the policy, certain policies may require an endorsement. A statement onthis certificate does not confer rights to the certificate holder in lieu of such
<br /> endorsement(s).THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT,
<br /> TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT
<br /> TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ABBC
<br />North Risk PartnersP.O. Box 64016St PaulThe City, its officers, employees, agents, volunteers and representatives are included as additional insureds on General Liability per form 80-02-2367
<br /> Rev5-07 and on Automobile per form 16-02-0292 Ed 4-11 when required in prior written contract. General Liability is primary and non-contributory per form80-02-2367 Rev 5-07 and Auto
<br /> Liability is primary per form 16-02-0292 Ed 4-11 when required in prior written contract. Waiver of Subrogation included onGeneral Liability per form 80-02-2000 & on Auto per form
<br /> 16-02-0292 when required in prior written contract. General Liability & Auto Policies have beenendorsed to provide 30 days notice of cancellation, with the exception of 10 days notice
<br /> of cancellation for non-payment of premium per form 80-02-9779and 16-02-0306 respectively. Umbrella Policy is follow form. Waiver of Subrogation is included on Workers' Compensation
<br /> Policies for all states exceptKentucky where prohibited by law utilizing the following policy forms: California WC 99 03 04, Texas WC 42 03 04, All Other States, Except Kentucky WC
<br />
<br />PRODUCERINSURED COVERAGES DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)CERTIFICATE HOLDERACORD
<br /> 25 (2016/03)
<br />LTR
<br />INSR
<br />
<br />
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