|
Francine R. Villareal wwun Signed by r„ndnzn
<br />ACORO' I o—anmm
<br />ATE u�ool
<br />L..� CERTIFICATE OF LIABILITY INSURANCE z/z3/zort
<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(les) 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 endersam•rdtal
<br />PRODUCER LiGimee R UMl WlU CO (TACT
<br />Armstrong/RobitaillelRlegle Business and Insurance Solutions PHONE
<br />$30 Roosevelt, Suite 200 (AtC N• E.O: (949) 381.7700 we N 1(948) 487-6151
<br />Irvine, CA 92620 1 S..__ wrrirlfn(rBal•.�nrn„n
<br />INSURED
<br />Families Forward
<br />8 Thomas
<br />Irvine, CA 92618
<br />COVFRARFC
<br />---- ---- �'-' ^"-""""'"`• REVISION UMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />TYPE OF INSURANCE
<br />ADDL
<br />I=SIIBR
<br />iffia
<br />POLICYNUMBER
<br />POLICY EFP
<br />7/1/2020
<br />POLICY EXP
<br />7/1/2021
<br />LIMIT$
<br />A
<br />X
<br />COMMERCIAL GENEMLL LIABILT'
<br />CLAIMS -MADE ❑X OCCUR
<br />X
<br />PHPK2153320
<br />EACH OCCURRENCE
<br />wLwGETO RENrm
<br />u�cP
<br />1,000,000
<br />100,000
<br />MED EXP An r ors arson
<br />20,000
<br />PERSONAL SAOV INJURY
<br />1 1,000,000
<br />NL AGGREGATE pLRIMpIT. AP �IESPER
<br />Poucy❑ JECT I •• LOC
<br />OTHER:
<br />GENERALAGGREGATE
<br />31000,000
<br />PRODUCTS -COMPR)PA G
<br />S 3,000,000
<br />A
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY Auro
<br />121l�1pE8pSONLY Al�lTOta,pSyULFA
<br />AUTLIS ONLY X AUTOS ONLB
<br />HPK2153320
<br />7/1/2020
<br />711/2021
<br />OOMBINED SINGLE LIMIT
<br />Me '
<br />BODILY INJURY Per person)
<br />EDGILY INJURY (Per accident
<br />OPERTV AMAOE
<br />oxidant
<br />S
<br />g 1,000,000
<br />S
<br />X
<br />S
<br />H OCCURRENCE
<br />S 4,000,000
<br />A
<br />X
<br />UMBRELLA LIAR X OCCUR
<br />EXCESS U-M
<br />Ae CLAIMS -MADE
<br />PHUS729673
<br />7/1/2020
<br />711/2021
<br />AGGREGATE
<br />4,000,000
<br />DEO I X I RETENTIONS 10,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOMPARTNERMXECUTNE Y N
<br />W.FnI!
<br />MIA
<br />SWC1293116
<br />7/1/2020
<br />7/1/2021
<br />X p� OTH-
<br />E.L EACH ACCIDENT
<br />1,000000
<br />A
<br />A
<br />MMN
<br />NW)
<br />r e&tleecdbe under
<br />P NOF OP TIONS below
<br />AbuselMolesI.
<br />Professional (E80)
<br />rPHPK2153320
<br />53320
<br />7/1/2020
<br />7/112020
<br />711/2021
<br />711/2021
<br />E.L. DISEASE -EA EMPLOYEE
<br />1,000,000
<br />E.L. DISEASE - POLICY LIMIT1,000,000
<br />Occurrence
<br />Occurrence
<br />1,000,000
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VENICLES (ACORD 101, Addlaonal Remark® Schedule, may be avachad It mare.paw Is required)
<br />The City of Santa Ana, Its officers, employees, agents, and representatives are named as Additional Inauretl on Primary and Non-Contribory basis with
<br />respect to General Liability coverage per attached forms as required In a written contract, agreement, or memorandum of understanding.
<br />30 Days Cancellation Notice unless 10 Days for Non -Payment.
<br />a-eonurary un, nm
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS,
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE
<br />,. .'^_ Rl MAhIgtmlaltDiisiun
<br />J�lA1Q(�yy.,n`�ir-/ pl REVIEWEDSMOJ PNm BY:
<br />ACORD 25 (2016103) ©1988S-2D15 ACORD C ��" ` f'�"�'^'d k' V:r°::. j
<br />The ACORD name and logo are registered marks of ACORD Risk Managenent An,ly:t
<br />
|