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A-2017-026-03 Digitally <br />ligned by Francine P. <br />Francine R. Villareal Villareal <br />Date: 202h.03.0208.02:40-08'00' <br />4�i CERTIFICATE OF LIABILITY INSURANCE OF <br />DATE1/7/20/YYYY) <br />1 I/72020 <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(!") must have ADDITIONAL INSURED or b <br />provisions eendorsed. <br />H SUBROGATION IS WANED, 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 certiflcate holder in lieu of such endomement(s). <br />PRODUCER <br />WNTACT <br />NAME: Lynette (Lynn) Eye <br />PIA Select Insurance Solutions <br />1100Industrial Rd, Y3 <br />ac. (SOS)975-3531 INC, N.): <br />ADDRESS: lynlLeyeGpiaselec[.com <br />INSURER(S) AFFORDING COVERAGE <br />NAICIt <br />San Carlos CA W70 <br />INSURER A: Amco Insurance Company <br />002014 <br />INSURED <br />INSURER B : Employers Insurance Group <br />10346 <br />Data Ticket, Inc. <br />INSURER C <br />DBA: Revenue Experts <br />INSURER D: <br />2603 Main Street, Ste. 300 <br />INSURER E <br />Irvine CA 92614 <br />INSURER F: <br />COVERAOE6 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 />LTR <br />TYPE OF INSURANCE <br />INSO <br />yyyD <br />POLICY NUMBER <br />(MMIDD <br />MMIDO <br />LWITS <br />A <br />X <br />COMMERCIALGENERN-UmIILrTY <br />CLAIMS -MADE 7K OCCUR <br />Y <br />Y <br />ACP G103069509589 <br />11/012020 <br />11/012021 <br />EACH OCCURRENCE <br />$ 2,000,000 <br />PREMISES(Ea accunence) <br />t 100,000 <br />APED EXP (Any one person) <br />t 5,000 <br />PERSONAL S ADV INJURY <br />$ 2,000,000 <br />GENL AGGREGATE LIMIT APPLIES PER: <br />X POLICY F-JJE T FILOC <br />OTHER <br />GENERAL AGGREGATE <br />s 4,000,000 <br />PRODUCTS-COMP/OP AGG <br />s 4,000,000 <br />$ <br />A'AAUUTOS <br />AUTOMOBILE <br />UAINLITY <br />ONLY AUTOSULED <br />HIRED NON-0WNED <br />AUTOS ONLY X AUTOS ONLY <br />ACP GLO 3069509589 <br />I1/012020 <br />I1/012021 <br />Ea acckent <br />$ 1.000,000 <br />BOOILYINJUW(Perperaoa) <br />S <br />JANYAUTO <br />BODILY INJURY (Per modern) <br />S <br />Per ecciden0 <br />s <br />t <br />A <br />X <br />USISRELLALWB <br />EXCESS LIAe <br />occult <br />CMMS+ E <br />ACP CAA 3069509589 <br />11/01/2020 <br />11/01/2021 <br />EACH OCCURRENCE <br />s 2,000,000 <br />AGGREGATE <br />F 2,000,000 <br />OED <br />I I RETENTIONS <br />$ <br />B <br />ORNERS COMPENSATION <br />kND EMPLOYERS LIABILITY YIN <br />MY PROPRIETOFUPARTNERrEXECUTIVE E <br />FFICER/MEMBER EXCLUDED? <br />ammtmy In NH) <br />yes, dee be under <br />ESCRIPTION OF OPERATIONS below <br />RIA <br />Y <br />EIG4581764-01 <br />IIIOM020 <br />1//0112021 <br />X STATUTE ER <br />El. EACH ACCIDENT <br />s 11000,000 <br />E.L.DISEASE-EAEMPLOYE-ES <br />1.000,000 <br />E.L. DISEASE -POLICY LIMIT <br />$ 1.000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD lal, Additional Remark. SchaduK may be attached N mare Space u required) <br />City of Santa Ana, officers, agents, employees, and volunteers are named as additional insured on the General Liability policy pursuant to written contract, agrectil or <br />memorandum of understanding. <br />The General Liability policy includes a Waiver of Subrogation, Primary & Non -Contributory warding and 30 day notice of cancellation as required by written contract (sec <br />attached). <br />Workers Compensation includes a blanket Waiver of Subrogation (sec attached). <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 AMC, 0REPRESENTATNE <br />20 Civic Center Playa, 4th Floor Santa Ana CA 92702 ManagmMrdDivatnn �=tom, lhak <br />- 01988-2015 ACORD 9 1e$ REVIEWED 6 APPROVED Br. <br />a.t.�;. <br />ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD tr' ' Fdl.e %, ViLVL 11 <br />Rak Management Analyst <br />