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<br />DATE (MM/DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE <br />Ejhjubmmz!tjhofe!cz! <br />08/13/2021 <br />THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER. <br />Bohjf! <br />THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHE <br />Bohjf!Bdfwfep! <br />POLICIESBELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S), <br />AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />Ebuf;!3133/14/28! <br />IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED, <br />Bdfwfep <br />subjecttothetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnot <br />26;68;55!.18(11( <br />confer rights to the certificate holder in lieu of such endorsement(s). <br />CONTACT <br />PRODUCER <br />NAME: <br />USI INSURANCE SERVICES LLC/PHS <br />FAX <br />(877)532-3486(888)443-6112 <br />PHONE <br />41715154 <br />(A/C, No): <br />(A/C, No, Ext): <br />The Hartford Business Service Center <br />E-MAIL <br />3600 Wiseman Blvd <br />ADDRESS: <br />San Antonio, TX 78251 <br />INSURER(S) AFFORDING COVERAGENAIC# <br />INSURED <br />INSURER A : <br />Sentinel Insurance Company Ltd.11000 <br />360 BC Group Inc <br />INSURER B : <br />1845 W ORANGEWOOD AVE <br />INSURER C : <br />ORANGECA92868-2051 <br />INSURER D: <br />INSURER E : <br />INSURER F : <br />COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: <br />THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD <br />INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS <br />CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHE <br />TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSRADDLSUBRPOLICY EFFPOLICY EXP <br />POLICY NUMBER <br />TYPE OF INSURANCELIMITS <br />LTRINSRWVD(MM/DD/YYYY)(MM/DD/Y YYY) <br />COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE <br />$2,000,000 <br />DAMAGE TO RENTED <br />CLAIMS-MADEOCCUR <br />$1,000,000 <br />X <br />PREMISES (Ea occurrence) <br />General Liability <br />$10,000 <br />MED EXP (Any one person) <br />X <br />PERSONAL & ADV INJURY <br />$2,000,000 <br />AX41SBAAD777109/01/202109/01/2022 <br />X <br />$4,000,000 <br />GENERAL AGGREGATE <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRO- <br />POLICYLOC <br />$4,000,000 <br />PRODUCTS - COMP/OP AGG <br />X <br />JECT <br />OTHER: <br />COMBINED SINGLE LIMIT <br />AUTOMOBILE LIABILITY <br />$2,000,000 <br />(Ea accident) <br />ANY AUTO <br />BODILY INJURY (Per person) <br />ALL OWNEDSCHEDULED <br />BODILY INJURY (Per accident) <br />AXX41SBAAD777109/01/202109/01/2022 <br />AUTOSAUTOS <br />HIREDNON-OWNEDPROPERTY DAMAGE <br />XX <br />AUTOSAUTOS(Per accident) <br />OCCUR <br />EACH OCCURRENCE <br />UMBRELLA LIAB <br />CLAIMS- <br />EXCESS LIAB <br />AGGREGATE <br />MADE <br />DED <br />RETENTION$ <br />WORKERS COMPENSATIONPEROTH- <br />AND EMPLOYERS' LIABILITYSTATUTE <br />ER <br />ANY <br />Y/N <br />E.L. EACH ACCIDENT <br />PROPRIETOR/PARTNER/EXECUTIVE <br />N/ A <br />E.L. DISEASE -EA EMPLOYEE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />E.L. DISEASE - POLICY LIMIT <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES(ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Those usual to the Insured's Operations. The City of Santa and its officers, employees, agents, and representatives are named as additional insureds <br />per the Business Liability Coverage Form SS0008 attached to this policy. <br />CERTIFICATE HOLDERCANCELLATION <br />SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLED <br />City of Santa Ana <br />BEFORETHEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVERED <br />Risk Management Division <br />IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 CIVIC CENTER PLZ FL 4 <br />AUTHORIZED REPRESENTATIVE <br />SANTA ANA CA 92701-4058 <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD <br /> <br />