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Francine R, neuurae�m Mr„nw.n
<br />Villareal w��inm.,uzn,zao.aeoroa
<br />TEROBERT-0 KSHIPPEY
<br />,4� O CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 123/2020
<br />1o/z3/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 BYTHEPOLICIES
<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 License # 0757776
<br />Newport Beach, CA - HUB International Insurance Services Inc.
<br />4695 MacArthur Court
<br />Suite 600
<br />CONTAAMC:CT
<br />PHONE FAX
<br />(AlQ No, Exl: (949) 623-3980 AIC, No):(949) 891-0407
<br />AEjjj�S .
<br />Newport Beach, CA 92660
<br />INSURERS AFFORDING COVERAGE
<br />NAIL#
<br />INSURER A: Executive Risk Indemnity
<br />35181
<br />INSURED
<br />INSURER a: Federal Insurance Company
<br />20281
<br />INSURER c: Travelers Property Casualty Company of America
<br />25674
<br />T.E. Roberts, Inc.
<br />INSURER D:
<br />306 W. Katella Ave Unit B
<br />Orange, CA 92867
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CFRTIFICATF NIIMRFR• 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 />ILT R
<br />TYPE OF INSURANCE
<br />INSD
<br />MD
<br />POLICY NUMBER
<br />POLOICOY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑X OCCUR
<br />X
<br />54310281
<br />911/2020
<br />9111202,
<br />EACHOCCURRENCE
<br />$ 1,000,000
<br />DAMAGE RENTEDncom
<br />PREMaMED
<br />$ 100,000
<br />EXP (Any oneperson)
<br />$ 5,000
<br />PERSONAL S ADV INJURY
<br />1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY YEo LOC
<br />GENERAL AGGREGATE
<br />2,000,000
<br />GEN'L
<br />PRODUCTS - COMP/OP AGG
<br />2,000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />OWNER ONLY AUTOS
<br />54310280
<br />911/2020
<br />9/112021
<br />COMBINED SINGLE LIMIT
<br />BODILY INJURY lPerperson)
<br />$ 1,000,000
<br />$
<br />BODILY INJURY Per accident
<br />$
<br />PeOaw tle t AMAGE
<br />$
<br />pp
<br />AUTOS ONLY POMP
<br />$
<br />C
<br />X
<br />UMBRELLALIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />ZUP-91NO3112.20-NF
<br />9/1/2020
<br />9/1/2021
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />10,000,000
<br />DED X RETENTION$ 10,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PRRRO//MEMBW, EXCLUDED?
<br />`Maud 0 In NER EXDLDDED4
<br />M�
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />54310282
<br />9/112020
<br />91112021
<br />1C PER OTH-
<br />ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />EL DISEASE -POLICY LIMIT
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />Re: Emergency Sewer and Water System Repair Services.
<br />The City of Santa Ana, Its officers, employees, agents, and representatives are included as additional insured as respects general liability, as required by
<br />written contract, and is primary and non-contributory, subject to the terms and conditions of the policy and attached forms. Separation of Insureds applies.
<br />30 day notice of cancellation, except 10 days for non-payment.
<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 92701 AUTHORIZED REPRESENTATIVE eMan� WekMnnagenv¢nEOMislgn
<br />�A� a a. I . REVIEWED&APPROVBDBY:
<br />ACORD 25 (2016103) ©1988.2015 ACORD C 9on F l fwlA +a R' v` "
<br />The ACORD name and logo are registered marks of ACORD ! RBk Management Analyse
<br />
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