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ACORV CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMa DYYYY) <br />04/28/2020 <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($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: R the certificate holder Is an ADDITIONAL INSURED, the policy(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 <br />CONTACT J8001 GOmBZ <br />NAME: <br />Tolman 8 Wiker Insurance Services, LLC <br />PHONE (805) 585-6161 A� Ne : (865) 5115-6161 <br />196 S. Fir Street <br />ADDRESS: 19omez(ajtolmanandtvikercem <br />PO BOX 1388 <br />INSU E S AFFORDING COVERAGE <br />MAIC $ <br />Ventura CA 93002-1388 <br />INSURER A: Hartford Fire Ins Co <br />19682 <br />INSURED <br />INSURER B: Hartford Casualty <br />29424 <br />Pacific Coast Cabling, Inc. <br />INSURER C. Hartford Ins Group <br />00914 <br />DSA: PCC Network Solutions <br />INSURER D: Landmark American Ins Cc <br />33138 <br />20717 Prairie Street <br />INSURER E: <br />Chatsworth CA 91311 <br />INSURER F <br />CERTIFICATE NUMBER: 20/2 <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTEO BELOW NAVE 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 />LTR <br />TYPE OF INSURANCE <br />INSO <br />VIVO <br />POLICY NUMBE0. <br />(MMr0DNYYY1 <br />UM <br />ERCIALGENEflALUMER1TY <br />EACH OCCURRENCE <br />S 1.000.000 <br />TOM, <br />LAIMB-MADE ® OCCURE <br />S 300,000 <br />MEDEXPA acre rson <br />s 10.000 <br />A <br />I <br />Y <br />Y <br />72UUNJH0752 <br />01/01/2020 <br />01/01/2021 <br />PERSONALSADVINUURY <br />S 1,000,000 <br />GENLAGGREGATELIMITAPPLIESPER: <br />GENERALAGGREGATE <br />5 2'000•GM <br />POLICY ©,ER° LOC <br />PRODUCTS-COMPIOPAGG <br />2.000.000 <br />S <br />OTHER <br />AUTOMOBILE <br />UASILT' <br />COMBINED S1 GLELIMIT <br />S 1000 Ogg <br />Ea d n <br />A"T'AUTO <br />BODILY IWURY(Fer perscn) <br />$ <br />A <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />72UUNJH0752 <br />01/01/2020 <br />01/01/2021 <br />BODILY INJURY(Per acddeM) <br />S <br />HIRED NONAWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Peracdden <br />$ <br />S <br />UMBRELLA DAB <br />OCCUR <br />EACH OCCURRENCE <br />S 10,000,000 <br />AGGREGATE <br />$ 10.000.000 <br />B <br />EXCESS Lue <br />CLAIMS -MADE <br />72RHUJH1103 <br />01/01/2020 <br />OV01/2021 <br />DEED <br />I >Q 10,000 <br />RETENTION S <br />S <br />WORKERS COMPENSATIONYINANDEMPLOYERSLIABILITY <br />OTH- <br />PER ER <br />C <br />ANY PROPRIETORPARTNEREXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />NIA <br />72WEAC2428 <br />01/01/2020 <br />01/01/2021 <br />E.L.EACHACCIDENT <br />S 1,000,000 <br />El DISEASE - EA EMPLOYEE <br />5 1-000,000 <br />(NantlatmyMNH) <br />U Yea, describe under <br />E.L. DISEASE - POLICY LIMIT <br />S 1.000,000 <br />DESCRIPTION OF OPERATIONS bebw <br />PROFESSIONAL LIABILITY <br />D <br />LHR839182 <br />01/0112020 <br />01/01/2021 <br />$1,000.000 Each Claim <br />Ded: $5,000 <br />$2,000.000 Agg Limit <br />Per Claim <br />DESCRIPTION OF OPERATIONS I I TONS I VEHICLES (ACORD tat, Addruanal RemmhsSchedule, may be attached N more space Is required) <br />GL: The City of Santa Are, Its officers, employees, agents, volunteers and representatives are Additional Insured as respects to operations of the Named <br />Insured par form H000010916. This Insurance is Primary A Non -Contributory l0 any other Insurance per form HG00010916. A Waiver of Subrogation is <br />added in favor of the Additional Insured per forth HG00010916. GL/AUMC : Notice of Cancellation applies per forms (GL/AU) 1H03130611 and (WC) <br />WC990394. Endorsement applies only as required by current written Contract on file. _,� <br />RFVIFWED & APPROVED <br />APR THE SHOULD <br />EXPIRA ION DATE THEREOF. TI NOTICE WILL BE DELED POLICIES BE CANCELLED BEFORE <br />DELIVERED IN <br />City of Santa Ana Risk Management Division ORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza /� _7 <br />4ih Floor ACEVE(IO <br />AUTHORUMD REPRESENTATIVE <br />Santa Ana CA 92702 I Q <br />019BB•201S ACORD CORPORATION_ All d.he. r..m .a <br />ACORD 25 (2016103) The ACORD name and logo are registered marks cf ACORD <br />