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Last modified
3/20/2024 10:36:41 AM
Creation date
11/20/2020 1:53:04 PM
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Contracts
Company Name
BRIGHTLIFE DESIGN LLC
Contract #
N-2020-208
Agency
Community Development
Expiration Date
11/30/2021
Destruction Year
2026
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Francine R. Digltallyslgned by <br />Francine R, Villareal <br />Villareal Date: 2020.1120 1e43:00 <br />-0e00' <br />ACII CERTIFICATE OF LIABILITY INSURANCE <br />111 <br />DATE (mm/oDM YY) <br />1 11/1812020 <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(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 andorSement(8). <br />PRODUCER <br />B2 Insurance Services <br />1426 Aviation Blvd, Suite 203 <br />Redondo Beach, CA 90278 <br />CONTACT <br />NAME: <br />Nice LLorin <br />aC Ne; (424)888-7660 <br />aooRess: pica b21nsurance.com <br />9k��=@b21nsurance.com <br />INSURERS AFFORDING COVERAGE <br />NAICit <br />License #: 0122551 <br />INSURERA: Ohio Security Insurance C mpany <br />24082 <br />INSURED <br />INSURER B: Am GUARD Insurance Company <br />42390 <br />Brightlife Designs LLC <br />INSURERc: American Fire and Casualty Company <br />24066 <br />16291 Gothard St <br />Huntington Beach, CA 92647 <br />INSURER D: <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 00006370-591763 REVISION NUMBER: R1 <br />THIS IS TO CERTIFYTHAT 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 />ILTE <br />TYPE OF INSURANCE <br />DDL <br />AINSD <br />SUER <br />Me <br />POLICYNUMBER <br />MMIDDIIYEYri <br />MMID�Y� <br />LIMITS <br />A <br />TCOMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE LFvlJ OCCUR <br />Y <br />Y <br />BLS58756204 <br />08/3112020 <br />08/31/2021 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />PREMISES Ea occurrence <br />$ 100.000 <br />GENL <br />X <br />MEDEXP(An oneperson) <br />$ 5000 <br />PERSONAL &ADV INJURY <br />$ 1000000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑ JECT LOG <br />OTHER: <br />GENERAL AGGREGATE <br />$ 2000000 <br />PRODUCTS-COMP/OP AGG <br />$ 2,000,000 <br />$ <br />B <br />AUTOMOBILELIABILITY <br />Hx <br />AWAUTO <br />OWNED <br />AUTOS ONLY X EROSULEO <br />HIRED NON -OWNED <br />AUTOS ONLY X AUTOS ONLY <br />Y <br />Y <br />BRAU048580 <br />10109/2020 <br />10109/2021 <br />(CEOs sVEINED SINGLE LIMIT <br />$ 1966996 <br />BODILY INJURY (Pre person) <br />$ <br />BODILY INJURY (Per ecddent) <br />$ <br />PROPERTY DAMAGE <br />Per eccldenl <br />$ <br />Comp/Coll Deduc <br />$ $1000 <br />C <br />X <br />UMBRELLA LIAB <br />EXCESS LIAR <br />X <br />OCCUR <br />CLAIMS -MADE <br />Y <br />Y <br />ESA58756204 <br />08/31/2020 <br />08131/2021 <br />EACH OCCURRENCE <br />$ 2,000,000 <br />AGGREGATE <br />$ 2,000,000 <br />DEB X RETENTION$ NA <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY <br />OFFICENMEM ER EXCLUDED ECUTIVE ❑ <br />(Mandatory in NH) <br />Dyyes, describe under <br />ESCRIP-DON OFOPERATIONS below <br />NIA <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Addlaonal Remarks Schedule, may be attached If more space is required) <br />City of Santa Ana, its officers, employees, agents and representatives are Additional Insureds with respect to General Liability <br />and Auto Liability per the attached endorsements or as required by written contract. Insurance is Primary and <br />Non -Contributory <br />City of Santa Ana - Risk Management Division <br />4th Floor <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />rarer: <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />Printed by NLL <br />�,. ltiekManagwnentDGfefon <br />rp �. REVIEWED&APPROVED BY z <br />Y <br />Risk Management Analyst <br />
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