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A-2015-155-03
<br />Francine R. Digitally signed by Francine
<br />R.Villareal
<br />Villareal Date: 2oZ0.M.1216:2523
<br />-0yN•
<br />Policy Number: 606755807
<br />Date Entered: 7 / 31 / 2 02 0
<br />CERTIFICATE OF LIABILITY INSURANCEI
<br />ATE pill
<br />D7/31/20201
<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 endorsement(s).
<br />PRODUCER
<br />B.W. Baker Insurance Inc.
<br />29169 Heatherclif£ g206
<br />Malibu, CA 90265
<br />Oo ACT
<br />NAME: Coro ' Maxim.
<br />arc Nrva Exl: (310)457-5092 FAX(310)4-97-6225
<br />E-MAIL
<br />ADOREss:
<br />INSURERS) AFFORDING COVERAGE
<br />III
<br />INSURER A: gOrine ace Fvrr. radedge
<br />2162E
<br />INSURED Elizabeth M Riley, Inc., dba Integra Realty Reso
<br />figgli,a a;Farveas Each=^.;°
<br />21628
<br />Orange County / Beth Finestone
<br />INSURER c: Fa'n"eas inEmCEOce Exchange
<br />21628
<br />INSURER D:
<br />2151 Michelson Or
<br />Irvine, CA 92612-1330
<br />INSURER E:
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 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 />INSR LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />Me
<br />POLICYNUMBER
<br />POLICYEFF
<br />M1RVOCIYYYY
<br />POLICYExP
<br />Mw OCIYYYY
<br />LIMITS
<br />A
<br />COMMERCIAL GENERAL LIABILITY
<br />EACHOCCURRENCE
<br />$ 1,000,000
<br />CUJMS-MADE®OCCUR
<br />X
<br />606755807
<br />B/1/2020
<br />8/1/2021
<br />PREMISESEaoOanence
<br />$75,000
<br />MED UP (My am person)
<br />$ 5,000
<br />PERSONAL&ADVINJURY
<br />$ Included
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$2,000,000
<br />POLICV ❑ JEC ❑ LOC
<br />PRODUCTS -COMPIOP AGO
<br />$ 1,000,000
<br />IS
<br />O HER:
<br />AUTOMO
<br />BILE LIABILITY
<br />EOMOIIE
<br />,madar
<br />$1,000,000
<br />A
<br />PNYAUTO
<br />X
<br />606755807
<br />8/1/2020
<br />8/1/2021
<br />BODILY INJURY (Per person)
<br />$
<br />OWNED
<br />AUTOS ONLY ACUTOESDULED
<br />BODILY INJURY (Par acidome)
<br />$
<br />ARED NON -OWNED
<br />UTOS ONLY AUTOS ONLY
<br />-PROPEIRTc`TFIXM�
<br />Permadent
<br />$
<br />B
<br />Use BELLA LIAB
<br />OCCUR
<br />X
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />Excess LlA6
<br />CLA MSMADE
<br />606755810
<br />e/1/2020
<br />8/1/2021
<br />AGGREGATE
<br />$
<br />DED RETENTION IS
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />-
<br />STATUTE ER
<br />EL. EACH ACCIDENT
<br />$ 1,000,000
<br />C
<br />AN PRO COTIVE ❑
<br />OFFICEOPRIETEREXCLODRIE
<br />(Mandeatory in NH)
<br />If yyes tlescdb8 )rider
<br />DES�RIPTIONOFOPERALONSbekw
<br />NIA
<br />X
<br />A09600402
<br />B/1/2020
<br />8/1/2021
<br />EL DISEASE -FA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Contents
<br />X
<br />606755807
<br />B/1/202o
<br />e/1/2021
<br />$53,000
<br />A
<br />Business Income
<br />X
<br />606755807
<br />8/1/2020
<br />S/1/2021
<br />ASL
<br />16 months
<br />DESCRIPTION OF OPERATIONS I LOCATONS I VEHICLES (ACORD 101, Additional Remarks Schedule, stay be allachM a more space is required)
<br />30 day notice of cancellation / 10 day notice of cancellation far non-payment
<br />City of Santa Ana, officers, agents, employees, and volunteers Inc named as additionally insured on this policy pursuant to written
<br />contract, a,,cement, or memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance
<br />carried by City shall be excess and mrsontribumry.
<br />Certificate Holder and the following am listed as additional insured:
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center PIa>a
<br />Santa Ana, CA 92702
<br />ACORD 25 (2016103)
<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 />AUTHORIZED REPRESENTATIVE
<br />The ACORD name and logo are registered marks of ACORD
<br />Produced! using Forms Boss Plus sa anni w.iw5onnsBoss rum; Impressive Publishing, LLC WD-208-197
<br />REA Management Divial
<br />REVIEWED S APPROVED BY:
<br />fps.[ Z W& Aui
<br />iLTWIllivil
<br />Risk Management Analyst
<br />
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