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Francine R.
<br />-I MAULL-1 Vindredl
<br />_-.__---_._.
<br />.4t�0/2O' CERTIFICATE OF LIABILITY INSURANCE
<br />1 °A11/13/2020Y)
<br />11/13/2020
<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 endorsements .
<br />PRODUCER 262-478-1000
<br />Bruce Gendelman Co., Inc.
<br />Suite 101
<br />CONTACT Diane Larson
<br />PHONE 262-478-1000 FAX 262-078-1001
<br />AIC, No, Ed: (AID, No
<br />W Brown Deer Rd
<br />E+�1aL , cilarson gendeiman.com
<br />Mil
<br />Milwaukee, WI 53217
<br />INSURE B AFFORDING COVERAGE
<br />NAIC#
<br />INSURERA:Phoenix Insurance Co
<br />25623
<br />INSURED
<br />INSURERS: Travelers Prop Cas CO of Amer
<br />25674
<br />Magellan
<br />Mr. John LLC
<br />Jn Honker
<br />450 Alton Road #1402
<br />Miami Beach, FL 33139
<br />INSURERC: Travelers Indemnity Of America
<br />INSURER
<br />25666
<br />INSURER D: Lloyd's of London
<br />INSURER E :
<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 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 />SUB
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPMffiDfyyyyf
<br />UNITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />1660SK446321
<br />04/12/2020
<br />04/1212021
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />DAMAGE RENTPREMISES fLa TE menoel
<br />$ 300,000
<br />MED UP (Any one erson
<br />$ 5,000
<br />PERSONAL& ADV INJURY
<br />$ 2,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY jE� LOG
<br />GENERALAGGREGATE
<br />$ 4,000,000
<br />GEN'L
<br />X
<br />N
<br />PRODUCTS-COMP/OPAGG
<br />$ 4,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />$ 2,000,000
<br />BODILYINJURY Per arson
<br />X
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOoS Ep
<br />AUTOS ONLY X ARNO50NLV
<br />16608K446321
<br />0411212020
<br />0411212021
<br />$
<br />BODILY INJURY Peracgdent
<br />8
<br />p rPwEld [DAMAGE
<br />$
<br />8
<br />B
<br />X
<br />UMBREUL LIAR
<br />EXCESS LIM
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />X
<br />CUP81K473520
<br />04/12/2020
<br />04/1212021
<br />EACH OCCURRENCE
<br />$ 3,000,000
<br />AGGREGATE
<br />$ 3,000,000
<br />DIED X RETENTION$ 5,000
<br />8
<br />C
<br />WORKERS COMPENSATION YIN
<br />ANO EMPLOYERS' LIABILITY
<br />OANY FFICERVEMBER EXCLUDED?ECUTIVE [
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS belmv
<br />NIA
<br />UB4K601189.20.42E
<br />04/12/2020
<br />04/1212021
<br />X PER OTH-
<br />T T E
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />D
<br />PROFESSIONAL LIAB
<br />B0621PMAGE000820
<br />04112/2020
<br />04/1212021
<br />EA CLAIM
<br />2,000,000
<br />$25,000 DEDUCTIBLE
<br />AGGREGATE
<br />23000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddiSonal Remarks Schedule, may be attached if more space is requiredl
<br />Agreement No. A-2018-096
<br />See additional pages for additional insured and primary / non-contributory
<br />coverages.
<br />City of Santa Ana
<br />Risk Management Div, 4th Floor
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />ACORD 25 (2016/03)
<br />CITSA03
<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 />AUTHORIZED REPRESENTATIVE
<br />✓_e'er'
<br />©1988-2015 ACORD CI
<br />The ACORD name and logo are registered marks of ACORD
<br />RLkMaruBemortZ1n_y:
<br />REVIEwEn fi APMtw® BY:
<br />fvu.a:n.e P1.
<br />Risk Management Analyst
<br />00
<br />
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