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DATE (MM/DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE <br />04/11/2021 <br />THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATE <br />HOLDER.THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGE <br />AFFORDEDBYTHEPOLICIESBELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHE <br />ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED, <br />subjecttothetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoes <br />not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />CONTACT NAME: <br />AUTOMATIC DATA PROCESSING INS AGCY <br />PHONEFAX <br />(800) 524-7024(800) 524-4013 <br />76250873 <br />(A/C, No): <br />(A/C, No, Ext): <br />1 ADP BLVD M/S 625 <br />E-MAIL ADDRESS: <br />ROSELANDNJ07068 <br />INSURER(S) AFFORDING COVERAGENAIC# <br />00914 <br />INSURER A :Hartford Fire and Its P&C Affiliates <br />INSURED <br />INSURER B : <br />360 BC GROUP INC <br />INSURER C : <br />1845 W ORANGEWOOD AVE <br />INSURER D : <br />ORANGECA92868-2051 <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 />EACH OCCURRENCE <br />COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />CLAIMS-MADEOCCUR <br />PREMISES (Ea occurrence) <br />MED EXP (Any one person) <br />PERSONAL & ADV INJURY <br />GENERAL AGGREGATE <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRO- <br />LOC <br />POLICY <br />PRODUCTS - COMP/OP AGG <br />JECT <br />OTHER: <br />COMBINED SINGLE LIMIT <br />AUTOMOBILE LIABILITY <br />(Ea accident) <br />ANY AUTO <br />BODILY INJURY (Per person) <br />ALL OWNEDSCHEDULED <br />BODILY INJURY (Per accident) <br />AUTOSAUTOS <br />HIREDNON-OWNEDPROPERTY DAMAGE <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 />X <br />AND EMPLOYERS' LIABILITYSTATUTE <br />ER <br />ANY <br />Y/N <br />E.L. EACH ACCIDENT$1,000,000 <br />PROPRIETOR/PARTNER/EXECUTIVE <br />N/ A <br />76WEGAD0P3F05/10/202105/10/2022 <br />A <br />$1,000,000 <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$1,000,000 <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 />