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Digital Iysigned by Francine R.
<br />Francine R. Villareal villa -al
<br />Date: 2021.01.13 10:57:38-08'00'
<br />WESTCOM-16 JBARTLESON1
<br />ACORL7µ' CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />10/5/2020
<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 # 0757776
<br />CONTACT
<br />NAME:
<br />PHONE FAX -8502
<br />(A/C, No, Ext): (951) 788-8500 No>:(951) 788
<br />HUB International Insurance Services Inc.
<br />3390 University Avenue
<br />Suite 300
<br />Riverside, CA 92501
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA:Sentinel Insurance Company,Ltd.
<br />11000
<br />INSURED
<br />INSURER B : Hartford Accident and Indemnity Company
<br />22357
<br />INSURERC:Axis Insurance Company
<br />37273
<br />Westbound Communications, Inc.
<br />INSURER D :
<br />625 The City Drive, Suite 480
<br />Orange, CA 92868
<br />INSURER E
<br />INSURER F :
<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 />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />72SBAIB4627
<br />5/6/2020
<br />5/6/2021
<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 />$ 2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />X
<br />POLICY PELT LOC
<br />PRODUCTS-COMP/OPAGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />2,000,000
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />72SBAIB4627
<br />5/6/2020
<br />5/6/2021
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />72SBAIB4627
<br />5/6/2020
<br />5/6/2021
<br />AGGREGATE
<br />$ 2,000,000
<br />DED X RETENTION $ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y/N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE [Y]
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />72WECLR3783
<br />9/28/2020
<br />9/28/2021
<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,UUU
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />C
<br />Professional Liab
<br />P-001-000174815-02
<br />9/25/2020
<br />9/25/2021
<br />Per Claim
<br />3,000,000
<br />C
<br />Retention: $10,000
<br />P-001-000174815-02
<br />9/25/2020
<br />9/25/2021
<br />Aggregate
<br />3,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The City of Santa Ana, it's officers, employees, agents, volunteers and representatives are Additional Insured in regards to General Liability perform
<br />IH12001185 which includes 30 Day Notice of Cancellation. Primary & Non -Contributory wording and Waiver of Subrogation coverages apply to the General
<br />Liability policy when required by written contract per the attached endorsement SS0008 04/05 (pgs. 16-17 of 24) & SS1215 03/00.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />ty
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL BE DELIVERED IN
<br />Risk Management Division
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />R
<br />ILLi3R M&T7Agt'.Ih12dUlNi8101t
<br />1'x
<br />REVIEWED & APPROVED BY.-
<br />1
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD C4
<br />The ACORD name and logo are registered marks of ACORD
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<br />Risk Management Analyst
<br />
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