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A-2020-043-03 <br />DocuSign Envelope ID: D62396E7-5ACC4072-B2AC-195DF71421 E2 <br />ACOR& CERTIFICATE OF LIABILITY INSURANCE °" as17nrz020 I " <br />gz0 <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 ADDRIONAL INSURED, the pollcy(ifi must have ADDITIONAL INSURED provisions or be endorsed. <br />R 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 />NAME: Carmencits Josef <br />Hays Companies Inc. <br />) 243-8200 —�•— 243-8201 <br />Concwrs. Suite p350 <br />osf®hayscdmpames.com4200 <br />Rs <br />INSURER(S) AFFORDING COVERAGE <br />NAICI <br />Ontario CA 91764 <br />WWRERA. Philadelphia Indemnity Ins Cc <br />INSURED / <br />INSURERS Insurance Co(1lpany of the West <br />Central Orange QDa91 f <br />BDy9 E Gs Clubs of Ql <br />INSURER C: <br />17701 Cowan, State 110 <br />INSURER D. <br />INSURER E <br />Irvine CA 92614 <br />w3URERF. <br />COVERAGES CERTIFICATE NUMBER: CL206197038 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 />Irm <br />ITN <br />TYPE Of INSURANCE <br />man <br />VAT, <br />P°LICYNUMMA <br />M Y <br />MWD YYY <br />LIMITS <br />COMMERCIAL DEMERAL LLEIUTY <br />J <br />/ <br />✓ <br />N CURit <br />1 Doo 000 <br />P <br />s 100.D00 <br />1PloCWMS.MDE ® OCCUR <br />feSMOnal Lhbsay <br />AI:D EXP An om <br />S 6,000 <br />Sexual Misconduct <br />PERSONAL A ADV INJURY <br />f 1.000.000 <br />A <br />Y <br />PHPK2125850 <br />04101rz020 <br />06MM021 <br />GEM AGGREGATE UNIT APPLIES <br />IES PER <br />GENERALAGOftEGATE <br />S 3,000.000 <br />POLICY ❑JEnti [:]LOC <br />PRODUCTS-COMPIOPAGG <br />S 3•000•00 <br />S <br />OTHER <br />AUTOMOBILE <br />LIABILITY <br />N SINGLE LIMIT <br />f D <br />X <br />AM•AUTO <br />BODIIYIWURY IP[I M>ml <br />S <br />A <br />Aov <br />LTO SCIffaLREo <br />AIROSONLV AUR)S <br />PHPK2125850 <br />04MIJ2020 <br />061OV2021 <br />EODILYIWURYIPPramdw,U <br />S <br />.'RED NON{ WD <br />v AI. <br />f <br />AUTOS ONLY AUTOS ONLY <br />P of <br />s <br />UMERELLA LIAR <br />OCCUR <br />FACn OGCURREHCE <br />S $•�•� <br />A <br />EXCESSLUB <br />CLMMSAwDE <br />PHUB719908 <br />0410112020 <br />(XIM11202i <br />AGGREGATE <br />s 5.000,000 <br />DIED <br />RETENTION S 10,0D0 <br />S <br />1WRNERSCOMPENSATON <br />M <br />AND EMPLOYERS LIABILITY YIN <br />i� <br />STaT <br />EL. EACH ACCIDENT <br />f 1,W0.000 1OFFI <br />B <br />ANV PROPRIETOt ARTNERlEXECU➢VE <br />MUEMBER EXCLUI <br />NIA <br />WIVE 505577300 <br />0610112020 <br />06,0112021 <br />EL DISEASE - EA EMPLOYEE <br />S 1.000.0ou <br />phn,il I"NNH) <br />'i IMtM00 vndM <br />WSCRIPTIONOFOPE"I'MrSe <br />E. L. DISEASE. POLICY LIMIT <br />1,000,000 <br />Cost <br />Ppecia <br />Blanket BPP <br />S921•DOO <br />A <br />Special Form <br />Farm <br />PHPK2125850 <br />0410112020 <br />061012021 <br />Deductible: El.l%t0 <br />DESCRIPTION OF °PERATNNS I LOCATIONS' VEHICLES (ACORD 101. AdPMnM 2.4. SrhAdi AA, M AnuAed N mwR XINPP A Mu'PW1 <br />City of Santa Ana• of¢ers, agents. empbyeas and volunteers We additional Insured on dwr General Liability only per card ar, contract, a r ement or <br />memorandum of understanding, Policy 5 is pnmary and and any Insurance carried by City snall be excess and non contributory <br />REVIEWED dl APP <br />30 day cancellation except 10 days for non payment of premium.,% By RISK MANIC-17MENT <br />OO pP0 <br />CERTIFICATE HOLDER CANCELLATION <br />FRANCINE R. VILLA <br />J <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 />ACCORDANCE WITH THE POLICY PROVISIONS <br />20 CIV¢ Center Plaza <br />AUTNORITEO REPRESENTATIVE <br />Santa Ana CA 92702 <br />l"'TLw.AltJ <br />01S8&2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />QVEC <br />'IVISION <br />f— <br />ZEAL <br />