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Francine R.
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<br />Villareal °a, e:M3DOB.031E:31]3
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<br />,acoRtf CERTIFICATE OF LIABILITY INSURANCE
<br />✓�
<br />DATE(MM/DDIYYYY)
<br />7/27/2020
<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 ADDITIONAL INSURED, the policy(ies) 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 endorsemengs).
<br />PRODUCER
<br />HUB international Insurance Services Inc.
<br />3636 American River Drive, Suite 200
<br />Sacramento CA 95864
<br />CONTA T
<br />NAME: ROCIo Leon
<br />PHONE 916480-4134 a/c No916-993-7234
<br />IL
<br />ADDRESS: Rocio.Leon hubinlernational.com
<br />INSURE S AFFORDING COVERAGE
<br />NAIL#
<br />INSURERA: Greenwich Insurance Company
<br />22322
<br />License#: 0757776
<br />INSURED WAREDIS-02
<br />Ware Disposal Inc.
<br />P.O. Box 1318
<br />INSURERS: Westchester Surplus Lines Insurance Co.
<br />10172
<br />wsuitl Alaska. National Insurance Company
<br />38733
<br />INSURER D: Indian Harbor Insurance Company
<br />36940
<br />Santa Ana CA 92702
<br />INSURER E:
<br />INSURER F :
<br />COVERA5E5 CERTIFICATE NUMBER: 27B481332 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 />ILSR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />POLICY NUMBER
<br />POLICYEFF
<br />IMMIDENYYY)n
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I-X-1 OCCUR
<br />Y
<br />GEC3000730-05
<br />2/28/2020
<br />"'JU#&M
<br />EACH OCCURRENCE
<br />$1,000,000
<br />DAMAG T RENTED
<br />PREMISES Ea oxurrerlce
<br />$100.000
<br />X
<br />MED UP (Any oneperson)
<br />$ 5,000
<br />$1,000 PD Detl.
<br />Per Occurrence
<br />PERSONAL B ADV INJURY
<br />s1,000,000
<br />SENT
<br />AGG REGATE U MIT APPLI ES PER:
<br />PRO-El
<br />GENERALAGGREGATE
<br />$2,000,000
<br />PRODUCTS-COMP/OPAGG
<br />$2,000,000
<br />POLICY JECT LOC
<br />$
<br />OTHER
<br />I
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />AECO04538605
<br />2/28/2020
<br />2/28/2021
<br />Ee COMBINEDSINGLE LIMIT
<br />$1,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY )
<br />(Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />BI/PD Deductible
<br />$10,000
<br />B
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />G46863306003
<br />2/28/2020
<br />2/28/2021
<br />EACH OCCURRENCE
<br />$10,000,000
<br />AGGREGATE
<br />$10,000,000
<br />X
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED I IRETENTION$
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILIITY YIN
<br />ANYPROPRIETOR/PARTNERIEXECUTIVE
<br />OFFICERIMEMBEREXCLUDEO?
<br />NIA
<br />20H WS 05450
<br />8/1/2020
<br />8/1/2021
<br />X STATUTE ERH
<br />E.L EACH ACCIDENT
<br />_
<br />It1,DOO,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in MR)
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT
<br />$1.000,000
<br />DESCRIPTION OF OPERATIONS below
<br />D
<br />Pollution It Remediation Legal
<br />Liability/CPL
<br />PECO056139
<br />2/28/2020
<br />2/28/2023
<br />Each Poll. Condition
<br />Aggregate
<br />Retention
<br />$5,00 ,000
<br />$10,000,000
<br />$10.000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />(General Liability Per Project Aggregate applies per written contract)
<br />RE: Work performed by the insured for certificate holder per written contract
<br />Additional Insured: City of Santa Ana; its officers, employees, agents, and representatives are additional insured with respect to General Liability and Auto
<br />Liability as required by contract.
<br />Forms: CG2010 0413, CG2037 0413, IX1405 0910, XIL431 0605, XIC411 1013
<br />City of Santa Ana
<br />Risk Management Division, 4th Floor
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AU�THAOtR,IED�REPRESENTATIVE
<br />'dr'V"�^-"
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<br />©1
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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<br />Risk Management Anayst
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