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Francine R.
<br />Villareal
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />Digitally signed by
<br />Francine R. Villareal
<br />Date: 2022.02.1 1
<br />DATE (MM/DD/YYYY)
<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 CONTACT
<br />WHINS Insurance Agency PHONE .... Stephanie Tran
<br />7610 BeverlyBlvd #48249 PHONE
<br />Ext) (818)233 0825 FAX No) (818)561-7117
<br />E-MAIL ........ ....... ................
<br />Los Angeles, CA 90048 ADDRESS Stephanie@whlns.com
<br />License #: OG66655 INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURERA AmG.UARD Insurance Comnanv �42390
<br />INSURED Igoe & Company, Incorporated INSURER,B Lloyd's of London ----
<br />DBA Igoe Administrative Services INSURER c Palomar Exce..ss and Surplus Insurance Compony----- 16754
<br />........
<br />10905 Technology PI Ste A INSURERD Hiscox Insurance Company --Inc 10200
<br />..........
<br />San Diego, CA 92127 INSURER.E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 00003536-319686 REVISION NUMBER: 41
<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 SUER POLICY EFF POLICY EXP LIMITS
<br />LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />IGBP256625
<br />09/03/2021
<br />09/03/2022
<br />EACH OCCURRENCE
<br />$ 1, 00,000
<br />CLAIMS -MADE I X OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES(Eaoccurrence)
<br />$. 50�000
<br />......... ......... ......... .........
<br />MED EXP (Any one person)
<br />$ 5 000
<br />... ........ ......... .........
<br />PERSONAL & ADV INJURY
<br />... ...
<br />$ 1,000,000
<br />.................
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />X-
<br />PRO -
<br />POLICY ECT l LOC
<br />PRODUCTS COMP/OP AGG
<br />$ 2,000,000
<br />OTHER:
<br />$
<br />A
<br />AUTOMOBILE
<br />---------
<br />LIABILITY
<br />IGBP256625
<br />09/03/2021
<br />09/03/2022
<br />COMBINED SINGLE LIMIT
<br />....-(Eaaccident) .....................................................
<br />$
<br />.....-1_,000,...0.0...........
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />........
<br />OWNED SCHEDULED
<br />.... ......... ......... .........
<br />BODILY INJURY (Per accident)
<br />......... .................
<br />$
<br />---------
<br />AUTOS ONLY .................. AUTOS
<br />X
<br />HIRED NON -OWNED
<br />X
<br />PROPERTY DAMAGE
<br />$
<br />AUTOS ONLY AUTOS ONLY
<br />_(Per accident) ...
<br />........... ...................................................
<br />A
<br />X
<br />UMBRELLA X OCCUR
<br />---------
<br />IGUM235783
<br />09/03/2021
<br />09/03/2022
<br />.... EACH OCCURRENCE
<br />$ 2,000,000
<br />...... ......... .................
<br />EXCESS LIAB CLAIMS -MADE
<br />AGGREGATE
<br />$ 2,000,000
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />IGWC301479
<br />03/01/2022
<br />03/01/2023
<br />X ATUTE OERH
<br />ST
<br />AND EMPLOYERS' LIABILITY Y / N
<br />- ---- ----
<br />.--- - --.
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH,ACCIDENT
<br />$ 1 ,000,000
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />.E ----...........................................
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1 ,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E L DISEASE POLICY LIMIT
<br />$ 1 ,000,000
<br />B
<br />Errors & Omissions
<br />MPL4298968.21
<br />11/05/2021
<br />11/05/2022
<br />Each Claim
<br />3,000,000
<br />C
<br />Cyber Liability
<br />QCB-250-OQK5PILM
<br />12/09/2021
<br />12/09/2022
<br />Aggregate
<br />3,000,000
<br />D
<br />Crime
<br />UC24068163.22
<br />02/09/2022
<br />02/09/2023
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Those usual to Insured's operations. City of Santa Ana, officers, agents, employees, and volunteers are additionally insured on
<br />this policy per endorsement BP 04 48 01 06. Such insurance as is afforded by this policy shall be primary, and any insurance
<br />carried by City shall be excess and noncontributory per CG 20 01 04 13.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of 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 AUTHOR�SENTATIVE Ii:AManagmentDMsian
<br />Santa Ana, CA 92702
<br />k4e 1°x REVIEWED &APPROVED BY.-
<br />1
<br />988-2015 ACORD C 1,- MER Risk Pjanagement Analyst
<br />ACORD 25 (2016/03) The ACORD name and logo are regi ered marks of ACORD Prin ,
<br />
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