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rranane h. FrancineRVillareal <br />Villareal Date: 1120.09.02 <br />10:18:53-07'00' <br />.ak`�/ZO CERTIFICATE OF LIABILITY INSURANCE <br />OAT 0831/22020 Y) <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. If <br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br />certificate does not confer rights to the certificate holder in lieu of such endomement(s). <br />PRODUCER <br />Ann Risk Services Northeast, Inc. <br />New York NY Office <br />One Liberty Plaza <br />165 Broadway, Suite 3201 <br />CONTACT <br />NAME: <br />(AJC PHONE <br />EXtl; C866) 263-7122 FAX C800) 3fi3-0105 <br />AIC. No. : <br />E-MAIL <br />ADDRESS: <br />New York NY 10006 USA <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURED <br />LOS Angeles SMSA LP <br />dba Verizon wireless <br />INSURER A: National Union Fire Ins Co of Pittsburgh <br />19445 <br />INSURER B: AIU insurance Company <br />19399 <br />1095 Avenue of the Americas <br />New York NY 10036 USA <br />INSURER C: American Home Assurance co. <br />19380 <br />INSURER D: New Hampshire Insurance company <br />23841 <br />INSURER E: <br />�.--------------------,...--- <br />INSURER F: <br />THIS IS TO CERTIFY THATTHE 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. Limits shown are as requested <br />INSR TYPE OF INSURANCEADDR SUER F Y E% <br />LTR INBD WVD POLICY NUMBER MMIDDIYYYY MMIDDM LIMITS <br />A <br />X <br />COMMERCKLGENERALUABILITY <br />CIAIMSMADE ❑X OCCUR <br />YY <br />GL <br />I <br />EACH OCCURRENCE <br />$2,000,000 <br />DAM <br />A ETORT <br />PREMISES Ea occurrence <br />$2,000,000 <br />% <br />MED E%P (Any one Person) <br />$10, 000 <br />XCU Coverage is Included <br />PERSONAL& ADV INJURY <br />$2.000,000 <br />GEN'LAGGREGATE PRO- PPLIEG PER: <br />RO- <br />% POLICY <br />JECT LOG <br />GENERALAGGREGATE <br />$5.000,000 <br />PRODUCTS-COMPUPAGG$5, <br />000, 0 00 <br />OTHER: <br />A <br />AUTOMOBILE LIABILITY <br />CA 4594298 <br />ADS <br />06/30/202006/30/2021 <br />COMBINED SINGLE LIMIT <br />Eaacddent <br />$1,000.000 <br />BODILY INJURY (Per person) <br />A <br />X ANYAUTO <br />CA 4594299 <br />06/30/202006/30/2021 <br />A <br />OWNED SCHEDULED <br />ATHIRED RUT AUTOS AUTOS NON OWNED <br />ONLY AUTOS ONLY <br />MA <br />CA4594300 <br />VA <br />06/30/2020 <br />O6/30/2021 <br />BODILY INJURY(Per a...car) <br />PROPERTY DAMAGE <br />Peraccident <br />A <br />I <br />See Next Page <br />06/30/2020 <br />06/30/2021 <br />UMBRELLA LIAR <br />H <br />OCCUR <br />EACHOCCURRENCE <br />EXCESS DAB <br />CLAIMS -MADE <br />AGGREGATE <br />DEO <br />RETENTION <br />B <br />O <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR/PARTNER! EXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatoryin NH) <br />If yes,DESCRIPTION <br />DESCRIPTION OF OPERATIONS below <br />IPTI NOFO <br />NIA <br />WC045886576 <br />AOS <br />WCQ4$866575 <br />CA <br />06/30/2020 <br />06/30/2020 <br />06/30/2021 <br />06/30/2021 <br />X PER STATUTE <br />OTH- <br />ER <br />E.L EACHACCIDENT <br />$1,000,000 <br />E.L. DISEASE -EA EMPLOYEE <br />$1,000,000 <br />EL DISEASE-POLICYLIMn <br />$1,000,000: <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES IACORD 101. Additional Remarks Schedule, may be aaached if more space is required) <br />The above -referenced General Liability policy shall cover the tort liability of the Certificate Holder assumed under the i <br />underlying agreement between parties for which the certificate has been issued. city of Santa Ana, its council members, I <br />officers and employees are included as Additional Insured with respect to the General Liability policy. The General Liability <br />policy shall apply as Primary and Nan -Contributory Insurance to each Additional Insured listed herein. Where permitted by law, , <br />the Named Insured parties listed herein waive all rights against City of Santa Ana, its council members, officers and employees . <br />listed herein for recovery of damages to the extent these damages are covered by the above -referenced General Liability policy <br />and, as further limited by written contract between the parties. <br />CERTIFICATE HOLDER CANCELLATION <br />city of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana CA 92701 USA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />POLICY PROVISIONS. <br />AUTHORIZED <br />-- S r®enuwr8elMaL utwlm <br />©1988-2016 ACORD CO [Seitam6/WFRov®BY: <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 11 " r'1,�P`b�'Id:- VAIVAC <br />Risk Management Analyst <br />