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A-2020-001-01 <br />CERTIFICATE OF LIABILITY INSURANCE OATE(M8/26I2019MONMI <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 pellcy(les) 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 NAME: Sherry Allen <br />SilverStone GroupAMEPHONE- -- — -- --'-- —'iFAX <br />—.— 11516 Miracle Hills Drive 1Afq,yp,ESq; 402-984-5644 <br />Suite 100 nuorsess: sellen@ a Loom <br />Omaha NE 68154 — <br />INSURENISI AFFORDING COVERAGE — <br />NgICe <br />- -- - -. __—_ ___ - <br />INSURED --- <br />INSURERA;Libertylnsurance CGmoralioq„ _ <br />42404 <br />OMS Facility Services LLC <br />INSURERS: Liberty Mutual Fire Insurance Co__ <br />E30 <br />INsuREq c: First Liberty insurance Cam. <br />DMS Facility Services Inc <br />33588 <br />Sout35 <br />Arroyo Drive <br />h <br />SDulh Pasadena CA 91030 <br />____ __ <br />INSURERS: AIG Spa Insurance Comcan <br />26883 <br />INSURER E: <br />COVERAGES <br />THIS <br />IS TO CERTIFY THAT THE POLICIES <br />S O <br />INSURANCE <br />uou <br />LISTED BELOW HAVE BEEN <br />REVISION NUMBER: <br />INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, <br />UI <br />TERM OR CONDITION OF ANY <br />ISSUED TO <br />CONTRACT <br />THE INSURED <br />NAMED ABOVE FOR THE <br />POLICY PERIOD <br />CERTIFICATE <br />MAY ISSUED MAY <br />POLICIE, <br />THE INSURANCE AFFORDED BY <br />OR OTHER <br />DOCUMENT WITH RESPECT <br />TO WHICH THIS <br />EXCLUSIONS <br />O <br />AND CONDITIONS OF SUCH <br />or <br />POLICIES. <br />LIMITS SHOWN MAY HAVE BEEN <br />THE POLICIES <br />REDUCED <br />DESCRIBED <br />HEREIN IB SUBJECT TO <br />ALL THE TERMS, <br />IN9R <br />—.._ - <br />ADDCITRR <br />BY <br />PAID CLAIMS. <br />L R <br />TYPE OFINSURANCE <br />POLICYNUMSER <br />POUCYEFF <br />mmcrYYYY <br />POUCYEXF <br />,owY <br />LIMITS <br />8 <br />TB2-691-468727-099 <br />1011/2019 <br />-= Q(.112020 <br />TXC2OM7M�SRCLALG6NElALUAARJTY <br />IMS-MADE I%tl OCCUR <br />EACH OCCURRENCE <br />DAMAGE TO RUTEO <br />$1.000,000 <br />- - - <br />PREMISES Ilia <br />§ 100.000 <br />--- <br />MEO UP IAny one p_maml <br />$10,000 <br />PERSONAL RAOV INJURY <br />$1.000,000 <br />--- — <br />------ <br />GENT AGGREGATLIMIT APPLIES PER: <br />EE <br />POLICY X PECT LOC <br />C <br />OENERALAGDREGATE <br />E2,000p00 <br />PRODUCTS-GOMPlOP AOd <br />—..- <br />$2.000,000 <br />- - J <br />C <br />OTHER. <br />ABILITY <br />AS691-068727-079 <br />10/112019 <br />10/112020 <br />CEOM0NtLE LIMIT <br />E <br />$1.000.000 <br />X ANY AUTO <br />n Iooll <br />eOMLY INJURY (Par person) <br />OWNED SCHEDULED <br />§ <br />eODILY INJURY (Per acoeanq <br />AUTOS ONLY AUTOS <br />HIRED Y <br />§ <br />_ AUTOS ONAUTOS ONLY <br />$ <br />PRGooDM1AGE- <br />lg!n,PgnnM1 <br />UMBRELLAUAB OCCUR <br />$ <br />-- <br />EXCESS L1AB <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />CLAIMS -MADE <br />S <br />— <br />ED <br />LIED RETENTION <br />- — <br />- - -- <br />A <br />WDRRERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />WA7-890458727-069 <br />10/1/2018 <br />10/1l20T0 <br />X PER O H- <br />$ <br />YIN <br />ANYPROPRIErORIPARTNEPIEXECUTIVE <br />OFSCERIMEMSEnEXCLUDED7 ❑ <br />NIA I <br />STATUTE R <br />--- - <br />-- <br />EL EACH <br />(Mandslary In NH) <br />ACCIDENT <br />- --- <br />5IAOa,000 <br />----- _ _ <br />If yyeeaa, dwwbe under <br />EL. OISEASE_EAEMPLOYEE <br />$1,000,000 <br />D <br />OE90RIPTIONOF OPERATIONS bebw <br />Cdblfty ors PapuSon <br />CPOIBO83533 <br />E.L. DISEASE - POLICY LIMIT <br />S1,000.000 <br />LIeMOty <br />10/1/2019 <br />10H/2020 <br />Each Loss <br />$1,000,DOO <br />Aggregele <br />51,000,000 <br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES p1COR0 f01, AtltllUonal Remade 9chativle, may be atteMetl II mars apace le ro9ulmtl) <br />Additional Insured an a prinlary and non-contributory basis Win respects to General Uabillly, <br />Including completed operations, as required by Written contract: <br />City of Santa Ana, Risk Management, it's officers, employees, agents, representatives, and volunteers. <br />Waiver of SUbrogalion Wilh respects to Workers Compensation#41ALItiired by written contract. <br />30 days' Notice of Cancellation provided with respdds t0•Gerferal Llabllily; Auto and Workers Compensation as required by Written <br />contract. <br />REVIEWED &APPROVED., <br />y Wisk <br />CERTIFICATE HOLDER A It <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana f ANCINE R. VI LARE A THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Risk Management Division <br />20 Civic Center Plaza, 4th Floor -' AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92702 �1444411 <br />wnnen ne rnnam <br />• — r.....— —ollu anu ,uUu are registered marKs Of ACURD <br />