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RIGHWAT-01 <br />HRAMIREZ <br />ACo120' CERTIFICATE OF LIABILITY INSURANCE <br />DAT913012020 <br />30/2020 <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 License # 0814758 <br />CONTACT <br />NAME: <br />PHONE FAX <br />(A/C, No, Ext): (818) 986-8200 (A/C, No):(818) 986-8510 <br />Hoffman Brown Company <br />5000 Van Nuys Blvd. 6th Floor <br />Sherman Oaks, CA 91403 <br />ADDRLSS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURERA:VI ilant Ins. Company <br />20397 <br />INSURED <br />INSURERS : Federal Insurance CO. <br />20281 <br />INSURERC: <br />Richards, Watson &Gershon <br />INSURERD: <br />350 South Grand Ave., 37th Floor <br />Los Angeles, CA 90071-3101 <br />INSURERE: <br />INSURERF: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FORTH POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TOM ICH THIS <br />CERTIFICATE MAYBE 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 LTR <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXP <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE X OCCUR <br />X <br />X <br />35293250 <br />10/1/2020 <br />10/1/2021 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />1,000,000 <br />$ <br />MED EXP (Any oneperson) <br />$ 10,000 <br />PERSONAL &ADV INJURY <br />$ 1,000,000 <br />GENU <br />AGGREGATE LIMITAPPLIES PER <br />JECTPRO- <br />POLICY PRO- X LOC <br />OTHER'. <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS-COMP/OPAGG <br />Included <br />$ <br />$ <br />B <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />AUTOS ONLY X AUTOS ONE <br />74967929 <br />10/1/2020 <br />10/1/2021 <br />COMBINED SINGLE LIMIT <br />Ea accitlent <br />1,000,000 <br />$ <br />BODILY INJURY Per P.rsi <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />X <br />Parr accRtlent AMAGE <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DED RETENTION$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOVERS'LIABILITY <br />YIN <br />ANY PROPRIETOR/ R/EXECUTIVE <br />EXCLUDED? <br />OFFICER/MEMBER EXCLUDED? <br />(ManUatory in NH) <br />f yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />71726476 <br />10/1/2020 <br />10/1/2021 <br />X PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />1,000,000 <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />E.L, DISEASE -POLICY LIMIT <br />1,000,000 <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />City of Santa Ana, its employees, officers and agents are named as an Additional Insured as required by written contract per Endorsement Form #80-02-2367 <br />attached. Coverage subject to policy terms, conditions and exclusions. <br />30 day notice of cancellation applies to the certificate holder in event of cancellation except for non-payment of premium is 10 days. <br />CERTIFICATE HOLDER CANCELLATION <br />Approved: A R <br />9/30/2020 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />City of Santa Ana <br />AUTHORIZED REPRESENTATIVE <br />Risk Management Division <br />Laura Rossini, Acting Chief Assistant City Attorney <br />�} <br />20 Civic Center Plaza, 4th floor <br />�+--/ W. <br />Santa Ana CA 92701 <br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />