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lie. 0 CERTIFICATE OF LIABILITY INSURANCE
<br />��
<br />DATE
<br />31/20 fIYYY)
<br />3/31 /2020
<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 />Woodruff -Sawyer & Co.
<br />2 Park Plaza, #500
<br />Irvine CA 92614
<br />CONTNAME, Katharine KatharlDe Tiller
<br />NAME,
<br />T7353
<br />. 94rine
<br />FAx
<br />A/c No : g49.476.3118
<br />E-MAIL
<br />ADOREss: ktiller wsandco.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC If
<br />INSURER A: Valley Forge Insurance Company
<br />20508
<br />INSURED ITERING-01
<br />1700 Carnegie Avenue, Suite 100 Inc.INSURER
<br />700
<br />INSURER B: Continental Insurance CompanyIteris,35289
<br />C: Columbia Casual Company
<br />31127
<br />Santa Ana CA 92705-5551
<br />IN6URERD:
<br />NSURER E:
<br />INSURER F :
<br />CUVEKAUts CERTIFICATE NUMBER: 644081801 REVIAInM MUMRCR-
<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 />LTR
<br />IET
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUER
<br />POLICY NUMBER
<br />POLICYEFF
<br />MM/DD
<br />POLICYEXP
<br />MMIDOIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 1XI OCCUR
<br />Y
<br />6057362701
<br />4/1/2020
<br />4/1/2021
<br />EACH OCCURRENCE
<br />$2,000.000
<br />DAMAGETORENTED
<br />PREMISES Ea occurrence
<br />$2,000,000
<br />MED EXP (Any one person)
<br />$15.000
<br />BI Ded. None
<br />PERSONAL &ADV INJURY
<br />$2.000,000
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY"JLOT IX I LOC
<br />GENERALAGGREGATE
<br />$4.000.000
<br />GEN'L
<br />PRODUCTS - COMPIOP AGG
<br />$4,000,000
<br />X
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILELIABILITY
<br />6057362682
<br />4/1/2020
<br />4/1/2021
<br />MBBINE.scrouSINGLE LIMIT
<br />$1,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY )
<br />(Peraccidenl
<br />-PROPERTY
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY F AUTOS ONLY
<br />-DAMAGE
<br />Per accident
<br />$
<br />OxneNHimd Com moll
<br />$ Ded's $1000
<br />A
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />6057362679
<br />4/1/2020
<br />4/1/2021
<br />EACH OCCURRENCE
<br />$25,000,000
<br />AGGREGATE
<br />$25,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED
<br />X I RETENTION$
<br />$
<br />B
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETORJPARTNERIEXECUTIVE
<br />OFFICEWMEMBEREXCLUDED?
<br />NIA
<br />6057544401
<br />6057S44415
<br />4/1/2020
<br />4/1/2020
<br />4/1/2021
<br />4/1/2021
<br />X STATUTE OERHE
<br />E.L EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe.rder
<br />DESCRIPTION OF OPERATIONSbelm
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,D00,000
<br />C
<br />Professional Uability,
<br />Claims Made Form
<br />Net. Date U101QD07
<br />652092957
<br />4/1/2020
<br />4/1/2021
<br />Llnlit$10,0D0.0001
<br />Deductible $100,000
<br />Agg$10,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: On -Call ITIS Agreement
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are designated as Additional Insured with respects General Liability.
<br />By It
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702 ___j
<br />MANAGEMENT LAVI'"
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />r�qr�� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ADD ni 117 /� I \ ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />k _ w
<br />rnRPnRATtr1M All .........,,.a
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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