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Francine R. Digitally signed by Francine R.
<br />Villareal
<br />Villareal Date: 2021.03.18 15:32:41 -07'00'
<br />GRAFPRO.01 JLAKSHMI
<br />11%f— "M" ATE (MMIDDIYYYY)
<br />41�1`i CERTIFICATE OF LIABILITY INSURANCE 2/19/2021
<br />I—- . . . .........
<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 />1-1 . I ----------- --------
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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
<br />,Concord, CA - HUB International Insurance Services Inc.
<br />'2300 Clayton Rd
<br />,Concord, CA 94520
<br />INSURED
<br />Graffiti Protective Coatings, Inc.
<br />419 North Larchmont, #264
<br />Los Angeles, CA 90004
<br />COVERAGESCERTIFICATE NUMBER:
<br />NAME.—,
<br />PHONE FAX
<br />(A/C, No, Ext): (925) 609-6500 (A/C, No):(925) 609-6550
<br />UMfiss: INSURER(S) AFFORDING COVERAGE NAIL #
<br />INSURER A: Colony Insurance Company 39993
<br />INSURER B: The First Liberty Insurance Corporation 33588
<br />INSURER c; Liberty Mutual Fire Insurance Company 23035
<br />INSURER D:
<br />INSURER EINSURER F
<br />REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW
<br />HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 TYPE OF INSURANCE ADDLSUBR POLICY NUMB
<br />J_1F,
<br />POLICY EFF POLICY EXP
<br />DIY LIMITS
<br />----MKDDIY — -----
<br />A X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />CLAIMS -MADE X OCCUR X PACEP4245050-02
<br />2117/2021 2/17/2022 DAMAGE TO RENTED 100,000
<br />PREMISES (Ea occurrence) $
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />GEN'L. AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGO 3REGATE S 2,000,000
<br />POLICY X PRO- CT LOC
<br />JF
<br />PRODUCTS - COMP/OP AGO 2,000,000
<br />OTHER.
<br />.. . .. ......
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT 2,000,000
<br />(Ea accident) $
<br />X ANY AUJ 0 X X AS6-Z91-466837-011
<br />1/1/2021 1/1/2022 BODILY INJURY (Per person) $
<br />OWNED SCHEDULED
<br />AUTO$ ONLY AUTOS
<br />BODILY INJURY (Pet accident) $
<br />HIRED NON -OWNED ED
<br />PROPERTY TAMAGE
<br />AUTOS ONLY AUTOS
<br />.(Per $
<br />UMBRELLA LIAR OCCUR
<br />EACH OCCURRENCE S
<br />EXCESS LIAR CLAIMS -MADE
<br />AGGREGATE $
<br />DED RETENTION $
<br />-COMPENSATION,__--_ ' _ - -_------ — ------- ---
<br />WORKERS"`--,,-
<br />AND EMPLOYERS' LIABILITY
<br />X PER OTH-
<br />STATUTE ER
<br />YIN X WC2-Z91-466837-021
<br />111/2021 1/1/2022 1,000,000
<br />ANY PROPRIETOP�/PARTNER/EXEc(i,rivii
<br />Y N/A
<br />E,L. EACH ACCIDENT.
<br />OFFICEFUMEMBER EXCLUDEDI�
<br />(Mandatory in NH)
<br />E. L, DISEASE - EA EMPLOYEE $ 1,000,000
<br />If yes, de cube under
<br />1,000,000
<br />L.L. DISEASE - POLICY LIMIT
<br />DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: Service Contract
<br />City of Santa Ana, its officers, agents, employees and representatives, as additional Insured as respects to General Liability per attached forms
<br />EPACE1 01 -0814 & EPACEI 00-0814, and coverage applies on a Primary & Non -Contributory
<br />basis per EPACE1 07-0714; and additional insured in respects to
<br />Auto Liability per AC8467 0415. Waiver of Subrogation applies to Auto Liability per AC8407 0713, pg. 10 of 11, XXIII, and Workers Compensation per
<br />WC040306 (4-84). As required by written contract.
<br />30-Day Notice of Cancellation for General Liability will be provided In accordance with attached form EPACE106-0714.
<br />__.......1.. ... . ......
<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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE
<br />.1
<br />. . ........ ......... Risk M-mg—entDivisLan
<br />ACORD 25 (2016/03) C7 1988-2015 ACORD CO REVIEWED & APPROVED BY.
<br />The ACORD name and logo are registered marks of ACORD
<br />F4M�e�w P1. Wl�
<br />Risk Management Analyst
<br />
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