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Dglllally's_6 by Francine R.
<br />Francine R.VillareaI a,eal
<br />Dale:2021.01.291L36.3I Noo'
<br />ONEOCOO.01 DTORRE
<br />A`ORO" CERTIFICATE OF LIABILITY INSURANCE
<br />°ATDIYYYY)
<br />1/28/22812021
<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 License # 0757776
<br />cRMENTACT Diana DeLaTorre
<br />N :
<br />New ort Beach, CA - HUB International Insurance Services Inc.
<br />4695PMacArthur Court
<br />Suite 600
<br />PHONE FAX
<br />(AIC, No, Est):(AID, No):
<br />nool{ESS: diana.deiatorre@hubinternational.com
<br />Newport Beach, CA 92660
<br />INSURERS AFFORDING COVERAGE
<br />NAIC N
<br />INSURER A: Philadell2hial Indemnity Insurance Company
<br />18058
<br />INSURED
<br />INSURER B :
<br />INSURER C
<br />OneOC
<br />INSURER D:
<br />1901 E. Fourth Street, Suite 100
<br />Santa Ana, CA 92705
<br />INSURER E ;
<br />INSURER F:
<br />"
<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 />ADDHIEp
<br />SUBR MID
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPLTR
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE [X] OCCUR
<br />X
<br />PHPK2220125
<br />1115/2021
<br />111512022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE
<br />T RENTEDPREMISES Ce
<br />$ 100,000
<br />MED EXP (Any one erson
<br />$ 5,000
<br />PERSONAL B ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIM IT APPLIES PER,
<br />POLICY D JEST LOD
<br />GENERALAGGREGATE
<br />$ 3,000,000
<br />GEN'L
<br />X
<br />PRODUCTS-COMP/OP AGG
<br />$ 3,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED
<br />O BIIN DSINGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJURY Perperson)
<br />$
<br />X
<br />ANY AUTO
<br />OWNED X SCHEDULED
<br />AUTOS ONLY AUTO..00SW
<br />PHPK2220125
<br />1/1512021
<br />1115/2022
<br />BODILY INJURY Per accident
<br />$
<br />P.0aCSdenl AMAGE
<br />$
<br />X
<br />E
<br />AUTOS ONLY X AUTOS ONNLV
<br />A
<br />X
<br />UMBRELLA LIAe
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />4,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />PHUB750959
<br />111512021
<br />1115/2022
<br />DIED X RETENTION$ 10,000
<br />ANDEPLYRS'LBIIY
<br />LIABILITY YIN
<br />ANY
<br />FFFICEgqD��MEM66ERwR EXCLUDED4 ECUTIVE ❑
<br />NIA
<br />AWE ERH
<br />STOMOE
<br />E.L. EACH ACCIDENT
<br />E.L. DISEASE - EA EMPLOYE
<br />1Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />I
<br />E.L. DISEASE - POLICY LIMIT
<br />A
<br />Prop. at Convention
<br />17
<br />PHPK2220125
<br />1/15/2021
<br />111512022
<br />Fairs or Conventions
<br />100,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule may be attached If more space Is required)
<br />The City of Santa Ana, its officers, employees, agents and representatives are Additional Insured with regard to General Liability when required by written
<br />contract per the attached endorsement form PI-GLD-HS (10/11), attached.
<br />Should the policies be cancelled before the expiration date, Hub International Insurance Services Inc. (Hub), independent of any rights which may be afforded
<br />within the policies to the certificate holder named below, will provide to such certificate holder notice of such cancellation within thirty (30) days of the
<br />cancellation date, except In the event the cancellation is due to non-payment of premium, In which case Hub will provide to such certificate holder notice of
<br />such cancellation within ten (10) days of the cancellation date.
<br />SEE ATTACHED ACORD 101
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cif of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />y Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE
<br />x `. RenEvyED&APPROVm BY:
<br />ACORD 25 (2016103) ©1988-2015 ACORD C
<br />The ACORD name and logo are registered marks of ACORD RKk Management Analyst
<br />
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