Laserfiche WebLink
Digitally signed by Ton Pierson <br />Tori Pierson Date: 2021.08.3112:16:33-07'00' <br />COMMLEG-01 VPAINTER <br />,d►coRO CERTIFICATE OF LIABILITY INSURANCE <br />#% <br />DATE(MM/DD/YYYY) <br />8/27/2021 <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 # OC32169 <br />CONTACT <br />NAME: <br />PHONE FAX <br />(A/C, No, Ext): (619) 937-0164 No):(619) 937-0168 <br />Rancho Mesa Insurance Services, Inc. <br />250 Riverview Parkway <br />Santee, CA 92071 <br />A DD E-MAIL <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURERA : Arch Insurance Company <br />11150 <br />INSURED <br />INSURER B : Service American Indemnity Company <br />39152 <br />INSURER 7 <br />Community Legal Aid SoCal <br />INSURER D7 <br />2101 North Tustin Avenue <br />Santa Ana, CA 92705 <br />INSURER E <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 1 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 />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE X OCCUR <br />x <br />AAPKG0046503 <br />9/1/2021 <br />9/1/2022 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />1,000,000 <br />$ <br />MED EXP (Any oneperson) <br />$ 25,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GENT <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />POLICY PRO X� LOC <br />PRODUCTS-COMP/OPAGG <br />$ 2,000,000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />1,000,000 <br />$ <br />BODILY INJURY Perperson) <br />$ <br />ANY AUTO <br />AAPKGO046503 <br />9/1/2021 <br />9/1/2022 <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 />$ 3,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />AAFXS0046503 <br />9/1/2021 <br />9/1/2022 <br />AGGREGATE <br />$ 3,000,000 <br />DED X RETENTION $ 0 <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />Y/N <br />ANY PROPRIETOR/ R/EXECUTIVE <br />SATIS0340101 <br />9/1/2021 <br />9/1/2022 <br />X PER R <br />STATUTE EER <br />E.L. EACH ACCIDENT <br />1,000,000 <br />$ <br />OF EXCLUDED? <br />EXCLUDED? ❑ <br />(Mandatory in NH) <br />N/A A <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />1,000,000 <br />$ <br />A <br />Abuse & Molestation <br />AAPKGO046503 <br />9/1/2021 <br />9/1/2022 <br />Occ. $1 M/ Aggregate <br />2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />RE: OPERATIONS OF THE NAMED INSURED AS CERTIFICATE HOLDERS INTEREST MAY APPEAR. <br />City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or <br />memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City shall be excess and <br />noncontributory. <br />CITY OF SANTA ANA <br />RISK MANAGEMENT DIVISION <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE <br />THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROM-2-2 <br />Rieie Mowgemenf Division <br />AUTHORIZED REPRESENTATIVE <br />-. ReoEwm & APPROVED BY: <br />4 '� <br />+ II,_ %mri Pe`ewaa <br />Risk Management Clerical Aisle <br />ACORD 25 (2016/03) © 1988-2015 ACORD C( <br />The ACORD name and logo are registered marks of ACORD <br />