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ACCIRbIr CERTIFICATE OF LIABILITY INSURANCE
<br />GATE IMMA DY WI
<br />-int+Ttsgo .
<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 polley(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 andorsoment(s),
<br />PRODUCER
<br />CONTACT NAME; A DBJohe
<br />Carnage Trade Insurance Agency, Inc.
<br />99 Tulip Avenue
<br />Pr COS (5is 350-5600 - (616) 358.5858
<br />A Ne .• )
<br />odeJohn@Carrlagelradeinsurance.com
<br />6keu,,.'I-.F.Joh—n@carriageiradeinsurance.com
<br />Suite 404
<br />Floral Perk NY 11001
<br />INSURER(Sl AFFOROINO COVERAGE
<br />NAIC9
<br />INSURERA: Phradelphla Indemnity Ins Co
<br />18058
<br />INSURED
<br />INSURERS: Redwood Fire S Casualty Insurance CO.
<br />Lutheran Social Services of Southern California '
<br />INSURER I
<br />436 West Orange Show Lane
<br />INRURER 0:
<br />Suite 104
<br />INSURER E: '_•'•_—__•'__•
<br />San Bernardino CA 92408
<br />INSU F:
<br />CUVERAGE5 CERTIFICATE NUMBER: Cusnnotu, REVISION NUMBER:
<br />THIS IS TO CERTIFY THATTHE 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 OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
<br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTOALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />Qfl
<br />TYPE OFINSURANC6
<br />SD
<br />POLICY NUMBER
<br />IMMIDD/yYYY
<br />and
<br />LIMITS
<br />COMMERCIAL OENERALUABILRY
<br />CIAIMSJMDE 9 OCCUR
<br />EACH OCCURRENCE
<br />t 1.000.000
<br />-INNAUETD7 EN .
<br />PREffmFS'E,acc."MIM)
<br />t 100.000
<br />MED SKIP (My one omepn
<br />t 5,000
<br />PERSONAL AADV INJURY
<br />If 1,000,000
<br />A
<br />Y
<br />PHPK2004825
<br />071011201g
<br />07101/7.020
<br />GENLAG(JISSI ELIMITAPPIJFSPER:
<br />POUCY ❑ JFMT LOC
<br />GENERALAGGREOATE
<br />S 3,000,000
<br />PRODUCTS-COMPIOPAGG
<br />t 3,000.000
<br />OTHER,
<br />Employee Benefits
<br />t 1,000,000
<br />AUTOMOBILE
<br />LIABILITY
<br />fie be"N,,,rDn SUI LE
<br />s1,000;000"
<br />,x
<br />ANYAUTO
<br />BODILY INJURY(P. parsdnl
<br />t
<br />A
<br />OWNED SCHEODUED
<br />AUTOS ONLY gUTO9
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PHPK2004825
<br />OVOU2019
<br />07101I202¢
<br />BODILY INJURY (Par aoaidenp
<br />B
<br />I Imm..Fran E
<br />t
<br />Medical Expense
<br />t 6,000
<br />X
<br />UMSREUUUAB
<br />X
<br />OCCUR
<br />EACHOCCURRENCE
<br />r 3,000,000
<br />A
<br />EXCESS LIAa
<br />OUly'JAUE
<br />FHUB603572
<br />0710V2019
<br />07/01/2020
<br />AGGREGATE
<br />s 3,000,000
<br />DED
<br />I X1 RETENnoN t 10.000
<br />s
<br />B
<br />WORRERSCOMPENSATION
<br />AND EMPLOYERS LABILITY YIN
<br />ANY PROPRIETORMARTNE111111UTIVE ❑
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mend.bo,I.NH)
<br />IryM.4Mcdb m&x
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />LUWC011852
<br />0%112019
<br />01101i2020
<br />PE0.
<br />STATUTE R
<br />E.L FACH ACCIDENT
<br />j;1.000,p00
<br />EALDISEItSE-EAEMPLOYEE
<br />S 1-000-000
<br />El DISEASE -POLICY OMIT
<br />it 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES LACORO tat, Additional RamaMe Schedule, may be attached If MOM apace Is rm,irad)
<br />City of Santa Ana, officers, agents. employees• and volunteers are Included as Addlonal Insureds as with respect to work performed by the Named
<br />Insured
<br />as required. by Hr{{'UUCCD Contract, agreement, or memorandum of understanding. Such Insurance as is afforded by this policy Shall be primary, and any
<br />InsurBnde cardedby City shall be excess and flancontrO)utgry.
<br />A thirty (30) day prior written notice of cancellation will be provided. Alan (10) Day notice of Cancellation will be provided for non payment of premium.
<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 Risk Management Division
<br />20 CIVIC Center PlaztREV ED & APPROVED
<br />By � MANAGEMENT DIVISION
<br />M Ana CA 92702
<br />ACCORDANCE WITH THE POUCY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />VG + r w..r ®1988.2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 120161031 The ACORD aRnn Inca are registered marks of ACORD
<br />A NTHA M. LAMBERT
<br />
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