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rranane h. Francine R. Villareal <br />Date: 2020.09.02 <br />Villareal <br />10:18:53-07'00' <br />'� �® CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMDD/1'Y Y) <br />0813112021) <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 INSURERIS), 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 />AOn Risk services Northeast, Inc. <br />New York NY Office <br />One Liberty Plaza <br />165 Broadway, suite 3201 <br />CONTACT <br />NAME: <br />PHONE (g6fi) 283-7122 <br />(AID. No. Extp FAIC tlg to C800) 363-0105 <br />EMAIL <br />ADDRESS: <br />New York NY 10006 USA <br />INSURER(S) AFFORDING COVERAGE <br />NAICN <br />INSURED <br />INSURERA: National Union Fire Ins CO of Pittsburgh <br />19445 <br />Los Angeles SMSA LP <br />dba Verizon wireless <br />INSURER B: AIU Insurance Company <br />19399 <br />INSURER C: American Home Assurance Co. <br />19380 <br />1095 Avenue of the Americas <br />New York NY 10036 USA <br />INSURER D: New Hampshire Insurance Company <br />INSURER E: <br />Tj <br />NSURER F: <br />COVERAGES GERI IHIGA I E Nuivi 5100uj/36tibb 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 />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested <br />LTR <br />TYPE OF INSURANCE <br />INSO <br />WVD <br />POLICY NUMBER <br />MMIDOMIYY <br />MM/DDIYYYYl <br />LIMITS <br />A <br />X <br />COMMERCIALGENERALLIABILITY <br />y <br />y <br />GL <br />EACHOCCURRENCE <br />$2,000,000 <br />CLAIMS -MADE ❑X OCCUR <br />D A ETORE TE <br />PREMISES Ea occurtence <br />$2,000,000 <br />X <br />MED EXP (Any one person) <br />$10, 000 <br />XCU Coverage is Included <br />PERSONAL a ADV INJURY <br />$2.000,000 <br />GEN'LAGGREGATE LIMITAPPLIES PER: <br />% POLICY PRO- <br />JECT LOC <br />GENERALAGGREGATE <br />$5,000,000 <br />PRODUCTS -COMPIOPAGG <br />$5,000.000 <br />OTHER: <br />A <br />AUTO MOBILE LIABILITY <br />CA 4594298 <br />ADS <br />06/30/2020 <br />06/30/2021 <br />COMBINED SINGLE LIMIT <br />accident <br />$1,000,000 <br />BODILY INJURY (Per person) <br />A <br />X ANYAUTO <br />CA 4594299 <br />06/30/2020 <br />06/30/2021 <br />A <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIREDAUTOS NON -OWNED <br />ONLY AUTOS ONLY <br />MA <br />CA 4594300 <br />VA <br />06/30/2020 <br />06/30/2021 <br />BODILY INJURY (Per accident) <br />PROPERTY DAMAGE <br />Per accident <br />A <br />See Next Page <br />06/30/2020 <br />06/30/2021 <br />UMBRELLA LIAB <br />OCCUR <br />ENCE <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED <br />RETENTION <br />B <br />C <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR I PARTNER I EXECUTIVE <br />OFFICERIMEMBER EXCLUDED] <br />N/A <br />WC045886576 <br />ADS <br />WC045886575 <br />06/30/2020 <br />06/30/2020 <br />06/30/2021UTE <br />O6/30/2021$1,000,000 <br />ffiDIS�SE-POLICY <br />OTH- <br />ER <br />IDENT <br />EA EMPLOYEE <br />$1,000,000 <br />(Mandatory in NH) <br />0 yes, describe under <br />CA <br />POLICY LIMIT <br />$1,000,000 <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addirional Remarks Schedule, may be atlached N more space is required) <br />The above -referenced General Liability policy shall cover the tort liability of the Certificate Holder assumed under the <br />underlying agreement between parties for which the certificate has been issued. City of Santa Ana, its council members, <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 Non -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 />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE J <br />POLICY PROVISIONS. - <br />city of Santa Ana AUTHORIZED REPRESENTATIVE - <br />Risk Management Division — <br />20 Civic Center Plaza, 4th Floor �saeaw�c/1 <br />Santa Ana CA 92701 USA <br />Risk Management Division <br />©1988-2015 ACORD CO ���APPROVED &' 6 <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD .��', Fua.c:+.a P, vj�a4 <br />® Falk Managcsnrnt Analy5l <br />