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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 />
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