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Dlgiolly Agnes by Frandre R. Francine R. Villareal'; .oM Date: 202o...0 17Az:15 area A� �� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD 20Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Kathy Williams Mt. Diablo Insurance Brokers, Inc. PHONE (925)297-4072 FAX No), 19251291-4e74 E-MAIL kath @mtdiabloinsurance.COM ADDRESS: Y 3557 Mt. Diablo Boulevard Suite 21 INSURERS AFFORDING COVERAGE NAICa INSURERA:U.S. Specialty Insurance Company 29599 Lafayette CA 94549 INSURED INSURERS: Travelers Casualty Insurance Company 19046 U S National Corp. INSURERC: DBA: Jimenez Painting INSURERD: 10205 San Fernando Road INsuRERE; INSURER F: Pacoima CA 91331 COVERAGES CERTIFICATE NUMBER:2020 A/L REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF fMMIDDNYYYI POLICY EXP IMMIDDIYYYYJLIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEOCCUR EACH OCCURRENCE $ 1,000,000 DAMAGETORENTED PREMISES Ea occunence $ 100, 000 MED EXP Any one person) $ 5,000 X U20AC 12407000 4/25/2020 4/25/2021 PERSONAL &ADV INJURY $ 1,000,000 GEN-LAGGREGATE LIMITAPPLIES PER POLICY ❑ PRP ❑ LOG X JECT GENERALAGGREGATE $ 2,000,000 PRODUCTS. COMPIOPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ee eccitlent $ 1,000,000 X BODILY INJURY (Per person) $ B ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS X BA7ND40727 6/3 /2020 6/3/2021 BODILY INJURY (Per eccitlenl) $ HIREDAUTOS AUTOS ED Parr celtlen DAMAGE $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 A EXCESS LIAB CIAIMS-MADE U20MI2407000 4/25/2020 4/25/2021 DED I I RETENTION $ I $ WORKERS COMPENSATION I PER OTH- ANDEMPLOYERS 'LIABILITY YIN ANY PROPRIEfORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑NIA STATUTE E E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ IMandatory In NH) If yea, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Addltlonal Remarks Schedule, may be aaached If more space Is required) RE: Agreement A-2018-005 and IFB 16-092 The City of Santa Ana, its officers, agents, employees, volunteers and represenatives are recognized as additional insured, but only as respects liability arising from named insured operations. Endorsements apply and are attached hereto. *30 days written notice of cancellation. 10 days notice for non-payment of premium. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 ACORD 25 (2014101) INS026 (2w o1) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Robert Salvo/BECKY Risk ManagonefllDlMialan s'ANREVIEWEDdr APPROVEDST: © 1988-2014 ACORD C 8s i; P c444,6h Z V;" The ACORD name and logo are registered marks of ACORD lamp Risk Management Analyst