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Client#: 25320 <br />KIMLHORN <br />ACORD. CERTIFICATE OF LIABILITY INSURANCE <br />D31281 v128/2020 20 <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 poiicy(ies) must have ADDITIONAL INSURED previsions 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 any rights to the certificate holder In lieu of such endorsement(s). <br />PRODUCER 0W. Jerry Noyola <br />Greyling Ins. Brokerage/EPIC PHONEIAIC. No. Eri: 770.552.4225 AN: No: 866-550-4062 <br />3780 Mansell Road, Suite 370 E# ft. <br />ADDRESS: lerry.noyola@greyting.com <br />Alpharetta, GA 30022 <br />INSURER(S) AFFORDING COVERAGE NAIL s <br />INSURER A: National Union Fire Ins. Co. 19445 <br />INSURED INSURERS: Aspen American Insurance Company <br />421Fayetteville Street, Suite 600 New Ham y-Horn ✓ INSURERC: pshire Ins. Co. <br />21 F <br />Raleigh, NC 27601 INSURER D: Lloyds of London <br />INSURER E: <br />43460 <br />23641 <br />85202 <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: 20-21 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />TR <br />TYPE OFINSURANCE <br />Aall <br />SUB <br />POLICY NUMBER <br />POLICY UP <br />PoLK' IXP <br />LIMITS <br />A <br />GENERAL LIABILITY <br />5268169 <br />/0112020 <br />04/01120211EAACHHOCCURRENCE <br />s 1000 000 <br />tXCMUERCIAL <br />CLAIMS -MADE OOCCURS50g000 <br />ntrect0al Liab <br />1 MEO ExP (Am ono person) <br />$25 000 <br />$1 00O 000 <br />I PERSONAL & ADV INJURY <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />$2000000 <br />GENERAL AGGREGATE <br />POLICY �JEC FLOC <br />PRODUCTS -COMPIOP AGO <br />$2,000000 <br />5 <br />OTHER. <br />A <br />AuToacalLE <br />LIABILITY <br />4489663 <br />4/01/2020 <br />04/0112021 COMBINED SINGLE LIMB <br />Ee a dent <br />2,000,000 <br />X <br />ANY AUTO <br />BODILY INJURY (Per person) <br />$ �— <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY Peraou enl <br />1. ( ) <br />S <br />_ <br />X <br />AUTOS ONLY X NON-0WNED <br />AUTOS ONLY <br />PROPERTY DAMAGE <br />_LPer .trident <br />S <br />S <br />B <br />UNBRELLALIAB <br />X OCCUR <br />CX005FT2O <br />4/01/202004/01/2021EACHOCCURRENCE <br />s5000000__ <br />X <br />EXCESSUM <br />CLAIMS E <br />AGGREGATE <br />$5 000 000 <br />OED I X1 RETENTION$0 <br />$ <br />C <br />WORKERS COMPENSATION <br />015893685 AOS <br />( )IRTATUTE <br />01/2020 <br />04/01J2021 <br />X 'PER OTH <br />PA <br />AND EMPLOYERS' UASIUTY <br />E.L. EACH ACCIDENT <br />A <br />ANY PROPRIETORIPARTNER/EXECUTIVE� <br />015893686(CA) <br />/01/202004/0112021 <br />$1000000 <br />OPFICERIMEMBER EXCLUDEOT N <br />(MandaMry In AIR) <br />NIA <br />E.L. DISEASE - EA EMPLOYEE <br />— <br />$1 00g 000 <br />DESCRIPTION OF OPERATIONS tool. <br />E.L. DISEASE -POLICY LIMIT <br />I $1,000000 <br />D <br />Professional Liab <br />B0146LDUSA2004949 <br />0410112020 <br />04/01/2021 <br />Per Claim $2,000,000 <br />Aggregate $2,000.000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD IN, Additional Remade ScMdute, may M anuhed N mart.Pace n rao irnd) <br />Re: On -Call Agreements A-2015-171, A-2017.108, A-2016-344, A-2017-273, A-2017.025, A-2009.212, A-2018-159 <br />01, A-2018-160-01 & A-2018-025. The City of Santa Ana, its officers, employees, agents & representatives are <br />named as Additional Insureds with respects to General & Automobile Liability where required by written <br />contract. The above referenced liability policies with the exception of workers compensation & professional <br />liability are primary & noncontributory where required by written contract. Separation of Insureds applies <br />(See Attached Descriptions) <br />CERTIFICATE HOLDER CANCFI 1 AnnN <br />City of Santa Ana By Risk MANACIEMENT Dit, <br />Risk Management Division AP 2U2II <br />20 Civic Center Plaza, dth Floor <br />SIANOULD ANY OF THE ABOVE DESCRIBED POLICIES aE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92702-0000 - <br />ANCfiE ACEVEdO <br />©tA,- <br />m 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) 1 of 2 The ACORD name and logo are registered marks of ACORD <br />#S2096705/M2095031 JNOY1 <br />