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Tori Pierson Digitally signed by Tori Pierson <br />Date: 2021.10.06 08:45:53-07'00' <br />ACOR" CERTIFICATE OF LIABILITY INSURANCE <br />FDATE (MM/DD/YYW) <br />0912212021 <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 Cathy Service Van Wyke-Stahl <br />Sargeant Insurance Agency, LLC. <br />A/c°Nr o Ext : (818) 561-2600 FAX No : (818) 436 5988 <br />E-MAIL <br />ADDRESS: <br />7740 Painter Avenue #210 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURERA: The Hartford <br />29424 <br />Whittier CA 90602 <br />INSURED <br />INSURER B : Indian Harbor Insurance Co <br />36940 <br />INSURER C <br />INSURER D: <br />BARTEL ASSOCIATES, LLC <br />INSURER E : <br />411 BOREL AVE STE 620 <br />INSURER F: <br />SAN MATEO CA 94402 <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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 />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 2,000,000.00 <br />CLAIMS -MADE X OCCUR <br />DAMAGE TO <br />PREMISES EaRENTED occurrence <br />000 <br />$ 2,000,000.00 <br />MED EXP (Any one person) <br />$ 15,000.00 <br />PERSONAL & ADV INJURY <br />$ 2,000,000.00 <br />A <br />Y <br />Y <br />57SBABN8199 <br />09/01/2021 <br />09/01/2022 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER : <br />GENERAL AGGREGATE <br />$ 4,000,000.00 <br />POLICYEl PRO LOC <br />JECT <br />X <br />PRODUCTS - COMP/OP AGG <br />$ 4,000,000.00 <br />$ <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 1,000,000.00 <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />A <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />N <br />57SBABN8199 <br />09/01/2021 <br />09/01/2022 <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTYDAMAGE <br />Per accident <br />$ <br />X HIRED IxNON-OWNED <br />AUTOS ONLY AUTOS ONLY <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYP ROPRI ETO R/PA RT N E R/EX EC UT I V E YIN <br />OFFICER/MEMBER EXCLUDED? N❑ <br />(Mandatory in NH) <br />NIA <br />Y <br />72 WEC AH2RPZ <br />09/01/2021 <br />09/01/2022 <br />X PER STATUTE OERH <br />E.L. EACH ACCIDENT <br />$ 1,000,000.00 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1 ,000,000.00 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1 ,000,000.00 <br />B <br />Professional Liability <br />MPP001715217 <br />09/01/2021 <br />09/01/2022 <br />Dam Lim a C aim <br />Dam Lim (Pol Agg) <br />,000,000.00 <br />5,000,000.00 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />CITY OF SANTA ANA, IT'S OFFICERS, OFFICIALS, EMPLOYEES, AND REPRESENTATIVES ARE HEREBY NAMED AS AN ADDITIONAL INSURED BY <br />WRITTEN CONTRACT OR WRITTEN AGREEMENT ON POLICY # 57SBABN8199 AS RESPECTS TO OPERATIONS OF THE NAMED INSURED <br />COVERAGE IS PRIMARY AND NON-CONTRIBUTORY ABOVE ANY OTHER INSURANCE THE CERTIFICATE HOLDER(S) MAY CARRY. 30 DAY NOTICE <br />OF CANCELLATION. <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 CIVIC CENTER PLAZA <br />AUTHORIZED REPRESENTATIVE Riefr><f�agaxenf IXvieion <br />APPROVED B": <br />Santa Ana CA 92701 <br />©1988-2015 ACORD C( - ns""ra"age <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />