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<br />'4� Raw CERTIFICATE OF LIABILITY/`h�9l !941& _ by i1i2022'')
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CEI 6J8XV®ER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND ORgLT�$6EV66F -NFD BYTHE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTF2/�F/BE�REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER., `\. VVV
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITION F L 'ASURED p i
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may re.auire an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER License # 0757776 CONTACT Michelle Vargas
<br />NAME:
<br />HUB International Insurance Services Inc. PHONE ) FAX
<br />P. O. Box 4047 (A/C, No, Ext): (916 770-2918 No>:(951) 231-2572
<br />Concord, CA 94524-4047 E-MAIL cal.cpu@hubinternational.com
<br />INSURED
<br />Graffiti Protective Coatings, Inc.
<br />419 North Larchmont, #264
<br />Los Angeles, CA 90004
<br />INSURERA: Colony Insurance Company 39993
<br />INSURER B:The First Liberty Insurance Corporation 33588
<br />INSURER C :
<br />INSURER E
<br />INSURER F :
<br />C(1VFRAr,FC CERTIFICATE KlIIMRFR• RFVICInKl KlIIMRFR-
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />PACEP4245050-03
<br />2/17/2022
<br />2/17/2023
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />100,000
<br />$
<br />MED EXP (Any oneperson)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY X JECT El LOC
<br />PRODUCTS - COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />2,000,000
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />X ANY AUTO
<br />X
<br />X
<br />AS6-Z91-466837-012
<br />1/1/2022
<br />1/1/2023
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />L
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />X
<br />WC2-Z91-466837-022
<br />1 /1 /2022
<br />1/1/2023
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE- EA EMPLOYEE
<br />$ 1,000'OOO
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / 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 />EPACE101-0814 & EPACE100-0814, and coverage applies on a Primary & Non -Contributory basis per EPACE107-0714; 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 />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ty ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE
<br />Ride Managtment Division
<br />fir% e @K REVIEWED & APPROVEDBY:
<br />ACORD 25 (2016/03) © 1988-2015 ACORD I
<br />The ACORD name and logo are registered marks of ACORD —r' Ri5k Management specialist
<br />
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