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Francine R. Digually signed! by Francine0. <br />VII Ylldreal <br />HSGING01$rfal Date: 2020.1 i.w 17 mClT iki <br />144CCIl' CERTIFICATE OF LIABILITY INSURANCE <br />°ATDA'YYY, <br />11/2/2I2I2020 <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 t0 the certificate holder in lieu of such endorsement(s). <br />PRODUCER License # 0757776 <br />Santa Barbara, CA - HUB International Insurance Services Inc. <br />PO Box 3310 <br />Santa Barbara, CA 93130-3310 <br />CONTACT <br />NAME Charlene Tran <br />PHONE FAX <br />Alt, Nq, Ext): (805) 879-9583 .vt, No):(803) 617-1762 <br />EMAIL . Charlene.Tran@hubinternational.com <br />INSURERS AFFORDING COVERAGE <br />NAIC N <br />INSURER A:West American Insurance Co <br />44393 <br />INSURED <br />INSURER B:Ohlo Security Insurance Company <br />24082 <br />HSG Inc <br />HSG, Inc DBA: Control Concepts <br />6925 Aragon Cir Ste 2 <br />INSURERC:American Fire and Casualty Company <br />24066 <br />INSURER D :Oak River Insurance Company <br />34630 <br />INSURER E <br />Buena Park, CA 90620 <br />NSURER 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 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 <br />TYPE OF INSURANCE <br />ADDL <br />SUBIR <br />POLICY NUMBER <br />POLICY EFF <br />POLIICOY EXPAJR_ JYYYYI <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL UABILPY <br />CLAIMS -MADE X OCCUR <br />X <br />BKW2058251804 <br />911/2020 <br />911/2021 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />DAMAGETORENTED <br />PREM SES Ea occurs e <br />500,000 <br />$ <br />MED EXP An one own <br />S 15,000 <br />PERSONAL& ADV INJURY <br />$ 1,000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY BELT 11 LOC <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN'L <br />PRODUCTS-COMP/OPAGG <br />2,000,000 <br />OTHER: <br />B <br />AUTOMOBILE <br />LIABILITY <br />MBINdocEDSINGLELIMIT <br />COIF <br />$ 10gg ggg <br />BODILY INJURY Per arson <br />Ix <br />ANY AUTO <br />OWNED SCHEDULEDAUTOS ONLY AUTOSBODILY <br />X <br />BAS58251804 <br />911/2020 <br />9/1/2021 <br />$ <br />INJURY Peraccidet <br />$ <br />AUTOS ONLY X AUUTOSS ONLYY <br />ParawRent AMAGE _ <br />$ <br />C <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 5,000,000 <br />AGGREGATE <br />5,000,000 <br />X <br />EXCESS LIAB <br />CLAIMS -MADE <br />ESA58251804 <br />9/1/2020 <br />911/2021 <br />DED RETEWION$ <br />D <br />WORKERS <br />ND EMPLOYERS' COMPENSATION <br />ANYPROPRIETORIPARTNER/EXECUTIVE YIN <br />K.FICERIMEMBER EXCLUDED? <br />(Mandatory in NH) <br />(cribe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />X <br />HSWC114972 <br />211/2020 <br />211/2021 <br />X PEq IRE OTH- <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE -EA EMPLOYE <br />$ 1'000,000 <br />E.L DISEASE- POLICY UNIT <br />1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached R more space is required) <br />The City of Santa Ana its officers, employees, agents, and representative are included as Additional Insureds under the General and Auto Liability policies, <br />additional insured coverage applies when required by written contract per the attached forms #CG 88 10 0413 & AC 85 43 0618. <br />*Primary and Non -Contributory wording is included under the general liability policy as stated on the form #CG 8810 0413 attached only.* <br />Waiver of Subrogation aplies to Worker's Compensation per attached form #WC 99 04 10 C (Ed. 01-19). <br />30 Days' Notice of Cancellation applies under General Liability and Auto Liability policies per attached forms #CG 20 61 0511 & CA 88 63 09 12. <br />This certificate replaces and voids certificate previously issued on 1012812020. <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 <br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE <br />Risk ugnnott a lan <br />n \c REVEwEDIEWED6A%'R01/B]BY: <br />ACORD 25 201fi/03 0I FaiAWY Z. kt6li a <br />( ) O 1988-2015 ACORD ClC ;�•; The ACORD name and logo are registered marks of ACORD Risk Management Analyst <br />