|
Francine R. Villareal' Vill'in .�s'a.a by r,a„n"rx,
<br />Mt. ro00e25 17u405 07W
<br />ACII CERTIFICATE OF LIABILITY INSURANCE
<br />`Ils.�
<br />DATE(MM/ODIYYYY)
<br />1 8/18/2020
<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 endorsement(s).
<br />PRODUCER
<br />Lovitt & Touchy A Marsh and McLennan Agency, LLC
<br />1050 W Washington Street, Suite 233
<br />Tempe AZ 85281
<br />CONTACI
<br />BBIS Fillicelli
<br />PHONE 602-385-7096 FAX
<br />A/C NO
<br />E-MAIL
<br />ADDRESS! bfllicelli lovitt-touche.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A! Pacific Compensation Insurance Co
<br />11555
<br />INSURED IECCORP-Cl
<br />(see Named Insured List attached) Corporation
<br />(se
<br />INSURER B: Argonaut Insurance Company
<br />19801
<br />INSURERC: National Fire Ins Cc of Hartford
<br />20478
<br />INSURERD: Valley Fore Insurance Company
<br />2050E
<br />16485 Laguna Canyon Road, #300
<br />Irvine CA 92618
<br />INsuRER E: The Continental Insurance Co
<br />35289
<br />INSURER F : Certain Underwriters at Lloyds, London
<br />COVERAGES CERTIFICATE NUMBER' 7179RR7n3 0cV1!9!0 l MIUMBEo.
<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 />INS
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />IMMIDWYYYY
<br />POLICY EXP
<br />(MMIDD1YVYY1
<br />LIMITS
<br />C
<br />X
<br />COMMERCIALGENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />Y
<br />Y
<br />6083274979
<br />7/31/2020
<br />7/31/2021
<br />EACH OCCURRENCE
<br />$11D00,000
<br />DAM ET RENTE
<br />PREMISES Eaoccurrence)$1,000,000
<br />MED EXP (Any one person)
<br />$16,000
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />X PRO
<br />POLICY JECT LOC
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GENT
<br />PRODUCTS-COMP/OP AGO
<br />$2,000,000
<br />$
<br />OTHER:
<br />D
<br />AIITOMOBILELIABILITY
<br />Y
<br />Y
<br />60/3271/12
<br />7/31/2020
<br />713112021
<br />COMBINED SINGLELIMIT
<br />Ea accident
<br />$1,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLYVAUTOS
<br />BODILY INJURY (Per award)
<br />$
<br />X
<br />HIRED NN-OWNED
<br />AUTOS ONLYAUTOS ONLY
<br />PROPERTY DAMAGE
<br />Peraccdent
<br />$
<br />X
<br />Cam &Coll Deductibles
<br />Deductibles
<br />$1,000
<br />E
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />Y
<br />Y
<br />6083274996
<br />7/31/2020
<br />7/31/2021
<br />EACH OCCURRENCE
<br />$15,000,000
<br />AGGREGATE
<br />$15,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED
<br />X RETENTION$
<br />$
<br />B
<br />WORKERAND SCOMPENSATION
<br />EMPLOYERS' T RY YIN
<br />OFFICE IMEMB RIPARTNEREXECUTIVE
<br />REXCLUDED9 ❑
<br />NIA
<br />Y
<br />WA-005984-01
<br />WC 928638713484
<br />6/1/2020
<br />6/112020
<br />6/1/2021
<br />6/1/2021
<br />X STATUTE ERH
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandataryb NH)
<br />(Mandatary InN
<br />If yea, describe under
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />F
<br />Student Professional Liability
<br />MPL1010320
<br />7/31/2020
<br />7/31/2021
<br />Each Claim
<br />$2,000,000
<br />Aggregate
<br />Deductible
<br />$4,000,000
<br />$15,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required)
<br />The above -indicated Additional Insured and Waiver of Subrogation (WOS) are provided with respects to General Liability, Automobile Liability, Workers'
<br />Compensation (WOS only) when required in a written and executed contract. Such coverage afforded by these policies General Liability policy for the benefit of
<br />the additional Insured(s) is primary and any other coverage maintained by such additional Insured(s) shall be non-contributory when required in a Written and
<br />executed contract. Excess Liability is Following Form.
<br />Supporting endorsements attached Include: CNA74879XX 1-15; CNA74857XX 1-16; GNA75014XX 1-15; SCA23500D 10-11; CA0444 10-13; WC99 03-15;
<br />WC000313 4-84; WC420304B 6-14; WC99 06-01
<br />CITY —Its officers. employees, agents, volunteers, and representatives are additional insureds when required by written contract.
<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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division, 4th Floor
<br />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92702 A--
<br />,Y------ weknlRnaBYmeRtD[wslmf
<br />REVIEWED&APPROVEDBY:
<br />01988-2015 ACORD C 8 `� F,ularlc e R `ix"
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORDRisk Management Analyst
<br />
|