|
Page 1 of 2
<br />^� ®
<br />A l.• CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM)DDNY YY)
<br />06/22/2020
<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 />CONTACT Willis Toxera Watson Certificate Center
<br />NAME:
<br />Willie Towers Watson Northeast, Inc.
<br />c/o 26 Century Blvd
<br />P.O. Box 305191
<br />PHONE FAX
<br />WC 1-877-945-7378 C N, 1-888-467-2378
<br />ADDRESScertificates@willis. com
<br />INSURERS AFFORDING COVERAGE
<br />NAICN
<br />Nashville, IN 372305191 USA
<br />INSURER A: Federal Insurance Company
<br />20281
<br />INSURED /
<br />INSURERB: National Union Fire Insurance Company of P
<br />19445
<br />Crown Castle International •/
<br />Sea Attached Named Insured List
<br />INSURER C: Berkshire Hathaway Specialty Insurance Com
<br />22276
<br />INSURER D: Nex Hampshire Insurance Company
<br />23841
<br />1220 Augusta Dr. Suite 600
<br />INSURERE:
<br />Houston, TK 77057
<br />INSURER F :
<br />1111..ncc PFDTICM`ATF MIIMOCD. W16005429 RFVIRInN NIIMRFR'
<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 />INSR
<br />R
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUSR
<br />POLICY NUMBER
<br />POLICY Err
<br />MMIDOMNY
<br />POLICY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCURV
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />A R
<br />PREMISES Ea occusence
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL& ADV INJURY
<br />$ 1,000,000
<br />Y
<br />Y
<br />3605-3335
<br />04/01/2020
<br />04/01/2021
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMPIOP AGG
<br />$ 2,000,000
<br />X POLICY JECT LOC
<br />S
<br />OTHER:
<br />I
<br />AUTOMOBILE LIABILITY
<br />X ANY AUTO
<br />✓
<br />COMBINED SINGLE LIMIT
<br />Ea soodant
<br />S 1,000,000
<br />BODILY INJURY (Per person)
<br />S
<br />BODILY INJURY (Per ams1ent)
<br />S
<br />B
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON WNEO
<br />AUTOS ONLY AUTOS ONLY
<br />Y
<br />Y
<br />CA 6631248
<br />04/01/2020
<br />04/01/2021
<br />PROPERTY DAMAGE
<br />Per acc ent
<br />$
<br />8
<br />C
<br />X
<br />UMBRELLALIAS
<br />EXCESS LIAR
<br />X
<br />1 OCCUR
<br />CLAIMS -MADE
<br />Y
<br />Y
<br />47-UMO-303445-05
<br />04/01/2020
<br />04/01/2021
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />F1
<br />AGGREGATE
<br />$ 5,000,000
<br />DED I X I RETENTION 25,000
<br />$
<br />O
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY
<br />ANYPROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICERIMEMBERE%CLUDEDa No
<br />(Mandatory In NH)
<br />If yes, desonbe antler ✓
<br />DESCRIPTION OF OPERATIONS bel.
<br />NIA
<br />Y
<br />WC 023096097
<br />04/01/2020
<br />✓
<br />04/01/2021
<br />'�
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />S 1,000,000
<br />E.L. DISEASE -EA EMPLOYE
<br />$ 1,000,000
<br />E L DISEASE- POLICY LIMIT
<br />S 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACOR0101, Adtlitional Rsmerka Schetlula. may he attacM1ed it more apace isrpulretl)
<br />This Voids and Replaces Previously Issued Certificate Dated 05/13/2020 WITH ID: W16459152.
<br />BUM827015 - Riverview Park, 1817 W. 21st Street, Santa Ana, CA 92706.
<br />THE CITY OF SANTA ANA, its officers, agents, representatives, employees and volunteers are included as Additional
<br />Insureds under the General Liability, Auto Liability and Umbrella Liability policies as their interest may appear and
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th floor
<br />Santa Ana, CA 92702
<br />1 I�`� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />JU ` �020 ACCORDANCETHE WITH THE POLICY PROVISIONSION DATE THEREOF, E WILL BE DELIVERED IN
<br />ANGLE ACEVECIO AU11R111 REPRESENTATIVE
<br />41s—
<br />)1,41
<br />ra 4On9_oM< Arr1Dn rncfDr1DATVIN All rinhYc rocorva
<br />ACORD 25 (2016/03)
<br />The ACORD name and logo are registered marks of ACORD
<br />Ss ID: 19759257 BATCH: 1719745
<br />
|