|
-:=®
<br />Hl_VKL CERTIFICATE OF LIABILITY INSURANCE
<br />141
<br />DATE(MMIDDNYYY)
<br />101082019
<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 CERTIFICATE
<br />THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE BY AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDTIONAL 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 endorsements .
<br />PRODUCER
<br />Marsh Risk & Insurance Services
<br />NAME.
<br />17901 Von Karmen Avenue, Suite 1100
<br />(949) 3W5800; License #0437153
<br />Irvine, CA 92614
<br />FHONE T —
<br />, ExD we N F
<br />Ea L
<br />ADDRESS:
<br />_ WSURERLS] AFFORDING COVERAGE
<br />iNSURER A: Harfford Accident &Indemnity Co.
<br />NAICe
<br />22357
<br />INSURE52723-STNDfiAUWP-0&
<br />suaEo
<br />Uredantl, Pacific 8 Gullet LLG
<br />3750 SchaU(9M Avenue,
<br />Suite 150
<br />IxsuRER e : Hartford Casuaft
<br />129424
<br />INSURERc: See Additional Page
<br />INSURER D : (ME Insurance Comora$on
<br />39217
<br />Long Beach, CA 90808
<br />INSURER E: _
<br />INSURER F:
<br />CDVFRARFS
<br />THIS
<br />INDICATED.
<br />CERTIFICATE
<br />EXCLUSIONS
<br />INSR
<br />LTR
<br />A
<br />IS TO CERTIFY THAT THE POLICIES
<br />NOTWITHSTANDING ANY REQUIREMENT,
<br />MAY BE ISSUED OR MAY
<br />AND CONDITIONS OF SUCH
<br />TYPE OFINSURANCE
<br />X COMMERCMLGEN;MLu BNtt
<br />CLAIM&MADE X OCCUR
<br />OF INSURANCE
<br />PERTAIN,
<br />POLICIES.
<br />INS
<br />X
<br />---^---^•
<br />Me
<br />LISTED BELOW HAVE BELN ISSUED TO
<br />TERM OR CONDITION OF ANY CONTRACT
<br />THE INSURANCE AFFORDED B" THE POLICIES
<br />LIMITS SHOWN MAY HAVE BEEN REDUCED BY
<br />POUCV NUMBR M�CYEFF
<br />IDUUNHFOU54 OB/102019
<br />THE INSURED
<br />OR OTHER
<br />DESCRIBED
<br />PAID CLAIMS.
<br />rtCVILIUIN NUMBER:
<br />NAMED ABOVE FOR THE
<br />DOCUMENT WITH RESPECT
<br />HEREIN IS SUBJECT TO
<br />POLICY PERIOD
<br />TO WHICH THIS
<br />ALL THE TERMS,
<br />MMNO�
<br />LIMITS
<br />DBI10020
<br />EACHOCCURRENCE
<br />5 1,000,000
<br />PREMISES Ea oaurren¢
<br />5 3Q0,000
<br />MED EXP (Any one Person)
<br />$ 10,000
<br />--
<br />PERSONAL&ADVIWURY
<br />S 1,000,000
<br />A
<br />5000NHF0064 Q81102019
<br />08/102020
<br />-
<br />GEML AGGREGATE LIMITAPPLIES PER:
<br />PRO.
<br />POLICY Q LOC
<br />E
<br />OTHER
<br />AUTOMOBILELIABILftY
<br />X ANV AUTO
<br />OWNED AUTOS LED
<br />AUTOS ONLY AUTOS
<br />X HIRED X NONOWNEO
<br />AUTOS ONLY AUTOS ONLY
<br />X COMP $1000 X COLL $1000
<br />Giu; R AGGREGATE
<br />11 2,000.OW
<br />PRODUCTS -COMPIOP AGO
<br />$ 2,000,000
<br />CO INE051 LEU
<br />Ee eo Merl
<br />5
<br />5 1,000.000
<br />BODILY INJURY (Per peraon)
<br />q
<br />BODLY INJURY (Per e¢idem)
<br />$
<br />POaac tle DAMAGE
<br />—
<br />$
<br />EACH OCCURRENCE
<br />$
<br />2,000.000
<br />X UMeRELLALIAB X OCCUR
<br />EXCESSLWB CLAIMSJMDE
<br />10RHWAS919 08110Wt9
<br />08110f1020
<br />AGGREGATE
<br />$ 2,OW.000
<br />$
<br />DE D X RETENTION 510000
<br />C
<br />WORKERS COMPENSATION
<br />ANDEMP40YERS•L1AmL YIN
<br />OFFCEDRIMEMB REXCWD pj ECIITIVE FN
<br />(Mandatory In NH)
<br />N!A
<br />IOWEAS9914 1
<br />010202
<br />X STATUTE Eftµ
<br />$
<br />E.L. EACH ACCIDENT
<br />E 1,0M.000
<br />$ 1,W0,000
<br />)
<br />Iryea, tlesmae untla
<br />DESCRIPTION OF OPERgT10Ns hebw
<br />Professional LiaNlity
<br />100003244 08110 019
<br />08/102020
<br />EL DISEASE-Eq EMPLOYE
<br />E.L ODISEASE-POLICY UMR
<br />Each Gabn Aggregate
<br />g 1,000,000
<br />2,000,000
<br />Deducible
<br />50 gg0
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, maybe alfached it mare space Is required)
<br />City of Santa Asa- its 0l6cers, employees, agents, volunteers and representatives are Included as additional insured where required by written contract wi(h rasped to General Liability. This insurance is primary and
<br />nowanutbutory over any existing insurance and limited to liability arising out of the operations of the named insured subject to policy terms and conditions -M respect to General Liability. Errors & Omissions
<br />Insurance Company will not provide 30 Day Notice of Cancellation M anyone, except do First Named Insure). Notce of Cancellation applies as per Me attached endorsements
<br />EVIEW &APPROVED
<br />CERTIFICATE HOLDER MFNTI litric; ..__.. __._..
<br />City of Santa Ana
<br />Risk Management, 4th Floor 42019
<br />20 civic Center Raze
<br />Santo Ana, CA 92702 S MANT A M. LAM
<br />A rnnn ne r.,,.a a,a.,.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />of Marsh Risk & Insurance Services
<br />Mai Mukhedee �vLgvLoor,:
<br />9)1988.2016
<br />••_ •+........ 11—le dnu 1og0 are registered marke of ACORD
<br />
|