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Francine R. D, nIy qnc b " °
<br />be—i
<br />Villareal 1,03 "°°'°°°"
<br />PALELLC-01 SSCHEIBE
<br />,4CORo" CERTIFICATE OF LIABILITY INSURANCE
<br />D11/19/202ATE YY)
<br />11/19/2020
<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
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (602) 992-9750 (AIc, No):(602) 992-9775
<br />Assured Partners
<br />7500 N. Dreamy Draw Dr., Ste. 100
<br />Phoenix, AZ 85020
<br />ADDRESS:
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC#
<br />INSURERA:Charter Oak Fire Ins. Co.
<br />25615
<br />INSURED
<br />INSURER B:Phoenix Insurance Company
<br />25623
<br />INSURERC:Travelers Prop Cas Co of Amer
<br />25674
<br />PaleoWest, LLC
<br />INSURER D: Landmark American Insurance Cc
<br />33138
<br />319 E. Palm Lane
<br />Phoenix, AZ85004
<br />INSURER E:The Continental Insurance Company
<br />35289
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 LTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />POLICYNUMBER
<br />POLICY EFF
<br />POLICY UP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE [X] OCCUR
<br />6307NO28185
<br />6/3/2020
<br />6/3/2021
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />300,000
<br />$
<br />MED EXP (Any oneperson)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GENU
<br />AGGREGATE LIMITAPPLIES PER
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />POLICY PRO LOD
<br />PRODUCTS-COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />OTHER'.
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />(COM BI NED S INGLE LIMIT
<br />Ea be dent)
<br />1,000,000
<br />$
<br />X
<br />BODILY INJURY Percenser)
<br />$
<br />ANY AUTO
<br />8107NO34898
<br />6/3/2020
<br />6/3/2021
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />(Per accRtlent AMAGE
<br />$
<br />AUTOS ONLY AUTOS ONE
<br />C
<br />X
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 21000,000
<br />EXCESS LABCLAIMS-MADE
<br />CUP71`1053692
<br />6/3/2020
<br />6/3/2021
<br />AGGREGATE
<br />$ 2,000,000
<br />DED X RETENTION$ 10,000
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECI-rIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />UB7N03885A
<br />6/3/2020
<br />6l3/2021
<br />X PER 01
<br />STATUTE ER
<br />E. L EACH ACCIDENT
<br />$ 1,000,000
<br />E. L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />f yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E. L. DISEASE -POLICY LIMIT
<br />1,000,000
<br />$
<br />D
<br />Professional E&O
<br />LHR840418
<br />6/3/2020
<br />6/3/2021
<br />PerClaiml$101K Ded
<br />5,000,000
<br />E
<br />Defense Base Act
<br />DBA6078883296
<br />7/23/2020
<br />6/3/2021
<br />Limit
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Professional E&O - Claims Made Ratio Date: 4-26-2007 ($2,000,000 limit); Professional E&O - Claims Made Ratio Date: 6-19-2019 ($5,000,000 limit) - Network
<br />Security & Privacy Limit is $250,000 - $10,000 Per Claim Deductible Applies to Indemnity & Expense.
<br />Certificate holders continued: City of Santa Ana, officers, agents, employees, and volunteers. Additional insured as respects general liability on a primary &
<br />non-contributory basis including a waiver of subrogation per forms CGD414 04-08 and CGD379 02-19 (attached). Additional insured as respects auto liability
<br />including a waiver of subrogation per forms CAT474 08-17 and CAT353 08-17 (attached). Waiver of subrogation on worker's compensation per form WC990376
<br />(attached).
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cityof Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Risk Management Division
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />_
<br />RiAManaganentDiuision
<br />REVIEWED & APPROVED BY:
<br />F4,Aar" Z' V`
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD Cla�
<br />The ACORD name and logo are registered marks of ACORD
<br />'�
<br />Risk Management Analyst
<br />
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