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<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(M1o/o2/2020/zozo
<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 pollcy(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
<br />Willie Towers Watson Insurance services west, Inc.
<br />o/0 26 Century Blvd
<br />P.O. Box 305191
<br />CONTACT Willis Towers Watson Certificate Center
<br />NAME:PHONE
<br />1-877-945-7378 FAX 1-888-467-2378
<br />A!C No:
<br />E-MAIL
<br />ADDRESS: certificates@willis.com
<br />Nashville, TN 372305191 USA
<br />INSLI AFFORDING COVERAGE
<br />NAIC#
<br />INSURERA: Westchester Surplus Lines Insurance Compan
<br />10172
<br />IThe Salvation Array - Division 11 NSURED
<br />INSURER B: Greenwich Insurance Company
<br />22322
<br />INSURER C: XL Specialty Insurance Company
<br />37885
<br />30840 Hawthorne Blvd., Bldg D
<br />INSURER D:
<br />Rancho Palos Verdes, CA 90275
<br />INSURER E :
<br />INSURER F :
<br />L:1JVtHAUt:5 CERTIFICATE NUMBER: WIUIUJU77 RFVISInN NIIMRFR-
<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 />ILTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDDcYYYYI
<br />POLICYEXP
<br />IMMIDDrITTI'lLIMITS
<br />COMMERCIAL GENERAL LIABILITYEACH
<br />CLAIMS -MADE � OCCUR
<br />OCCURRENCE
<br />$ 2,000,000
<br />I
<br />DAMA T RENTED
<br />PREMISES Eaoccurenoe$A
<br />1,000,000
<br />MED EXP Any one person)
<br />$ 0
<br />9elf Insured Retention:
<br />y
<br />G7183119AC01
<br />10/01/2020
<br />10/01/2021
<br />x
<br />$2,000,000
<br />PERSONAL &ADV INJURY
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑, JECT �LOC
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />PRODUCTS-COMPIOPAGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />I
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 5,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />H
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />y
<br />RAD500021910
<br />10/01/2020
<br />10/01/2021
<br />BODILY INJURY Per accident
<br />( )
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY -DAMAGE
<br />Per accldant
<br />$
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED I I RETENTION$
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETORIPARTNERIEXECUTIVE No
<br />OFFICERIMEMBEREXCLUDED7
<br />NIA
<br />y
<br />RWD500021710
<br />10/01/2020
<br />10/01/2021
<br />x PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory In NH)
<br />If yea, dearnica under
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />DESCRI PTION OF OPERATIONS below
<br />B
<br />Excess Auto Liability - CA
<br />RAE500021810
<br />10/01/2020
<br />10/01/2021
<br />Any Auto / CSL
<br />$3,000,000
<br />Self-Insd Retention
<br />$2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be aft ched if more space Is required)
<br />Division k11-148
<br />Workers Compensation:
<br />Policy No. RWD500021710 provides coverage in the following states: HI, ID, MT ,NM, NV, UT
<br />Policy No. RWR300094405 provides coverage in the following states: AK
<br />SEE ATTACHED
<br />I Izm I tr WA I C INULUCR CANCELLATION
<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 />City of Santa Ana
<br />Risk Management Division
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza ea, Vc 01 �
<br />Santa Ana, CA 92702 i• 1/( =� I W
<br />©1988.2016 ACORD CORPORATION. All riahts reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />sR ID: 20160526 BATCH: 1836068
<br />
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