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<br />Digitally signed by Francine R.
<br />Villareal
<br />Francine R. Villareal
<br />Date: 2021.01.28 16:38:12 -08'00'
<br />HOUS&HA-01SGUILLEN
<br />DATE (MM/DD/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />1/26/2021
<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 />CONTACT
<br />License # 0C36861
<br />PRODUCER
<br />NAME:
<br />PHONEFAX
<br />Inland Empire-Alliant Insurance Services, Inc.
<br />(909) 886-9861(909) 886-2013
<br />(A/C, No, Ext):(A/C, No):
<br />685 Carnegie Dr Ste 265
<br />E-MAIL
<br />San Bernardino, CA 92408
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGENAIC #
<br />Colony Insurance Company39993
<br />INSURER A :
<br />INSURED
<br />Nationwide Mutual Insurance Company23787
<br />INSURER B :
<br />Travelers Casualty and Surety Company of America
<br />31194
<br />INSURER C :
<br />Houston & Harris P C S Inc
<br />21831 Barton Road
<br />Cypress Insurance Company10855
<br />INSURER D :
<br />Grand Terrace, CA 92313
<br />Landmark American Insurance Company33138
<br />INSURER E :
<br />INSURER F :
<br />COVERAGESCERTIFICATE 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 />INSRADDLSUBRPOLICY EFFPOLICY EXP
<br />TYPE OF INSURANCEPOLICY NUMBERLIMITS
<br />LTRINSDWVD(MM/DD/YYYY)(MM/DD/YYYY)
<br />1,000,000
<br />A
<br />COMMERCIAL GENERAL LIABILITY
<br />X
<br />EACH OCCURRENCE$
<br />DAMAGE TO RENTED
<br />100,000
<br />CLAIMS-MADEOCCUR
<br />X
<br />103GL0024297-026/24/20206/24/2021
<br />$
<br />PREMISES (Ea occurrence)
<br />XX
<br />5,000
<br />MED EXP (Any one person)$
<br />1,000,000
<br />PERSONAL & ADV INJURY$
<br />2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$
<br />PRO-
<br />2,000,000
<br />X
<br />POLICYLOC
<br />PRODUCTS - COMP/OP AGG$
<br />JECT
<br />OTHER:$
<br />COMBINED SINGLE LIMIT
<br />1,000,000
<br />B
<br />AUTOMOBILE LIABILITY
<br />$
<br />(Ea accident)
<br />X
<br />ANY AUTO ACP30666457406/24/20206/24/2021
<br />BODILY INJURY (Per person)$
<br />XX
<br />OWNEDSCHEDULED
<br />AUTOS ONLYAUTOSBODILY INJURY (Per accident)$
<br />PROPERTY DAMAGE
<br />HIREDNON-OWNED
<br />XX
<br />(Per accident)$
<br />AUTOS ONLYAUTOS ONLY
<br />$
<br />4,000,000
<br />C
<br />X
<br />UMBRELLA LIABOCCUR
<br />EACH OCCURRENCE$
<br />ZUP-41N13398-20-NF6/24/20206/24/2021
<br />4,000,000
<br />EXCESS LIABCLAIMS-MADE
<br />X
<br />AGGREGATE$
<br />10,000
<br />X
<br />DEDRETENTION$
<br />$
<br />PEROTH-
<br />WORKERS COMPENSATION
<br />D
<br />X
<br />STATUTEER
<br />AND EMPLOYERS' LIABILITY
<br />Y / N
<br />HOWC1165729/1/20209/1/2021
<br />1,000,000
<br />X
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT$
<br />N / A
<br />OFFICER/MEMBER EXCLUDED?
<br />1,000,000
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYEE$
<br />If yes, describe under
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$
<br />Prof LiabilityLHR8405726/24/20206/24/2021
<br />Agg/Each Claim Limit2,000,000
<br />E
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Job: Agreement A-2017-364-01 and A-2017-223-01.
<br />City of Santa Ana is an additional insured, waiver of subrogation as respects to general liability per endorsements attached; additional insured, waiver of
<br />subrogation as respects to auto liability per endorsement attached; waiver of subrogation as respects to workers compensation per endorsement attached.
<br />Cancellation Notice, per attached endorsements.
<br />CANCELS AND REPLACES THE CERTIFICATE ISSUED ON 9/2/2020.
<br />CERTIFICATE HOLDERCANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Drive
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702
<br />ACORD 25 (2016/03)© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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