|
Francine R. Olgltally signed by
<br />i : Francine
<br />ne Rp.�Villar�eta�l5
<br />WESTGRdd Iareal Dara. F'Hi'1VI52
<br />. 1kii CERTIFICATE OF LIABILITY INSURANCE
<br />D/YYVY)
<br />OAT/3112020
<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 License # 0757776 CONMTA
<br />NAE: CT Pam Alaimo
<br />Riverside, CA - HUB International Insurance Services Inc. (AIC Nr u. ExO: (951) 779.8742 FAX Na )
<br />PO Box 5345
<br />'.� E-MAIL
<br />Riverside, CA 92517 AOD E, Pam.Alaimo@hubinternational.com
<br />INSURER(S) AFFORDING COVERAGE NAIC 9
<br />Ali
<br />_
<br />_ INSURER A: The Travelers Indemnity Company of Connecticut 1125682
<br />INSURED I. INSURER B: Travelers Property Casualty Company of America
<br />25674
<br />Westland Group, Inc. I INSURER C : National Union Fire Insurance Company of Pittsburgh, PAi
<br />19445
<br />4150 Concours Street, Suite 100 I INSURER 0:
<br />Ontario, CA 91764
<br />1 INSURER E :
<br />I 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:, '.ADDL SURRI
<br />LTRTYPE OF INSURANCE POLICY NUMBER
<br />POLICY EFF
<br />nauvrenry
<br />POLICY EXP
<br />I
<br />LIMITS
<br />A 'i, X COMMERCIAL GENERAL LIABILITY
<br />_ I
<br />CLAIMS -MADX'6$0-2J$21$$7 $/24/2020
<br />5l24/2021
<br />EACH OCCURRENCE
<br />2,000,000
<br />oEcNcCE
<br />O
<br />ERENTED
<br />EeB�e
<br />1,000,000
<br />$
<br />PTneMED EXAno
<br />5,000
<br />INJUY
<br />2000000PERSONALBADV
<br />GENERALAGGREGATE
<br />1$ 4,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER I I !
<br />POLICY X PEA LOC I
<br />PRODUCTS - COMP/OP AGG_;;
<br />$ 4,000,000
<br />OTHER:
<br />! $
<br />B AUTOMOBILE LIABILITY
<br />I. 1
<br />X ANY AUTO I X Ii1 BA2A157031 5/24/2020
<br />OWNED SCHEDULED
<br />i .J AUTOS ONLY AUTOSW
<br />5/2412021
<br />COMBINED SINGLE LIMIT
<br />(Ea a
<br />r�ccltlenl)�
<br />1,000,000
<br />1 BODILY INJURY (Per person)
<br />$
<br />'-
<br />BODILI YINJURY(Per accldentl.$
<br />p
<br />—j AiIT OS ONLY AUTOS ONV j
<br />Pe�acoiEent AMAGE
<br />_
<br />I $ -
<br />$
<br />C ! UMBRELLA LIAB X I OCCUR •I
<br />X EXCESS LIAB I CLAIMS-MADEII '.., •1EBU 020434749 5/2412020
<br />5/2412021
<br />EACH OCCURRENCE
<br />$ 7,000,000
<br />:AGGREGATE - _
<br />$ 7,000,000
<br />.PFOd/COmp Agg
<br />$ 7,000,000
<br />1 DED RETENTION$
<br />WORKERS COMPENSATION
<br />:ANDEMPLOYERS'LIABILITY YIN
<br />ANPY PROWPRIIETgORIPARTNER/EXECUTIVE h
<br />(t�antlalary in HR) EXCLUDED? i,� I N / A
<br />H)
<br />1 It yes, describe under
<br />:DESCRIPTION OFOPERATIONS b
<br />'PER OTH-
<br />�I�@TATUTE ER
<br />E.L EACH ACCIDENT
<br />r �-
<br />EL DISEASE -EA EMPLOYEE'
<br />I -- -�
<br />E,L MSEASE-POLICYLIMIT
<br />$
<br />$ ---
<br />DESCRIPTION OF OPERATIONS ( LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />Regarding General Liability the City of Santa Ana, officers, agents, employees, and volunteers are additionally insured perform CG2010 (pending receipt from
<br />the company) on this policy pursuant to written contract, agreement, or memorandum of understanding; Primary Non Contriubtory per attach form #CGD381
<br />09115; refer to form #ILT400 12/09 for Notice of Cancellation - 30 Day , except 10 notice for non-payment of premium. Regarding Auto Liability, Additional
<br />Insured and Primary Non Contriubtory per attached form CAT474 02116 for City of Santa Ana, officers, agents, employees, and volunteers; refer to form
<br />CAT805 50/18 for Notice of Cancellation - 30 Day, except 10 notice for non-payment of premium.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cityof Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE
<br />REVIEWED &
<br />ppy, P(rgR�_+�APPROVE)
<br />ea:+¢*A �p..6
<br />ACORD 25 (2016103) ©1988-2015 ACORD C
<br />The ACORD name and logo are registered marks of ACORD RhItManageptentApn
<br />
|