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Francine R, Villareal Digitally signed by Francine R. Villareal <br />Date: 2021.04.08 09:05:57-07'00' <br />AcoRtf CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDNYYY) <br />3/19/2022 <br />1 3/17/2021 <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 orbe 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 endomement(s). <br />PRODUCER LOCkton Insurance Brokers, LLC <br />License #01715767 <br />4275 Executive Square, Suite 600 <br />La Jolla CA 92037 <br />NAME:CT <br />PHONE FA% <br />Ext : WC, Not: <br />EMAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIL$ <br />(858)587-3100 <br />INSURER A: National Fire Insurance Co of Hartford <br />20478 <br />INSURED UPS Group, Inc. <br />137790E 77371Cenamar Court <br />INSURER B : Valle Forge Insurance Com an <br />20508 <br />INSURER C : The Continental Insurance Company <br />35289 <br />San Diego CA 92121 <br />INSURER D : Lloyd's Syndicate 457 (Munich Re Syndicate Limited) <br />INSURER E: American Casualty Company of Reading, PA <br />20427 <br />INSURER F : <br />COVERAGES 1PSOR01 CERTIFICATE NUMBER: 1)R07519 RFVIQlnm MI WIRER• vvv1111 <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 />ILTR <br />TYPE OF INSURANCE <br />ADDLSUBR <br />INSD <br />MirPOLICY <br />NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MWDOIYYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE IN] OCCUR <br />Y <br />N <br />4034952942 <br />3/19/2021 <br />3/19/2022 <br />EACH OE <br />s 1000000 <br />TO RENTEE <br />PREMISES Ea occurrence <br />$ 1000 000 <br />MED EXP (Any one person) <br />$ 15,000 <br />PERSONAL S ADV INJURY <br />$ 1000000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY ]JECT LOG <br />GENERAL AGGREGATE <br />$ 2000000 <br />GENT <br />PRODUCTS - COMP/OP AGO <br />$ 2000000 <br />$ <br />OTHER: <br />E <br />AUTOMOBILE <br />LIABILITY <br />N <br />N <br />6013847872 <br />3/19/2021 <br />3/19/2022 <br />COMBINED ISINGLE LIMITEa <br />$ 1000000 <br />X <br />X <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />BODILY INJURY (Per person) <br />$ XXXXXXX <br />BODILY INJURY (Per accident) <br />$ XXXXXXX <br />PROPERTY DAMAGE <br />fPer accident) <br />$ XXXXXXX <br />Com ./C ll. Ded <br />$ 1,000 <br />C <br />X <br />UMBRELLA LIAR <br />X <br />OCCUR <br />N <br />N <br />4014952990 <br />3/19/2021 <br />3/19/2022 <br />EACH OCCURRENCE <br />$ 20.000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />AGGREGATE <br />$ 20,000.000 <br />DED RETENTIONS <br />I <br />$ XXXXXXX <br />E <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOWPARTNEWEXECUTIVE Y/N <br />OFFICEWMEMBER EXCLUDED? � <br />(Mandatory in NH) <br />If yes, describe uIaer <br />NIA <br />NPER <br />5093308451 ((CA`{1, <br />5093308496 (AOS1 <br />3/19/2021 <br />3/19/2021 <br />3/19/2022 <br />3/19/2022 <br />OTH- <br />X STATUTE ER <br />. <br />E.LEACH ACCIDENT <br />_ <br />$ I OOQ QQQ <br />E.L. DISEASE- EA EMPLOYEE <br />$ 1 000 000 <br />E.L. DISEASE -POLICY LIMIT <br />$ 1,000000 <br />DESCRIPTION OF OPERATIONS below <br />D <br />Tech E&O/Network/ <br />Privacy / Media <br />N <br />N <br />CYYE63501(E&O) <br />3/19/2021 <br />3/19/2022 <br />Each Occ. 5,0001000; <br />Agg.: 5,000,000; <br />Ded.: 100,000 <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more spaco is required) <br />THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND LEE POLICY TERM(S) REFERENCED. <br />RE: RFP 14-012, Modernization of Downtown Parking Meters. City of Santa Ana, its officers, employees, agents, volunteers and representatives are an <br />Additional Insured to the extent provided by the policy language or endorsement issued or approved by die insurance carrier, Insurance provided to Additional <br />Insured(s) is primary and non-contributory as per the attached endorsements or policy language. Notice of Cancellation applies per attached endorsement(s). <br />12892512 <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />©1'986=2015 AG <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />sR lilskMniagrntmtDldalan <br />REVIE�GED&APPROVm BY: <br />, E,.e 1tkPAtuct <br />Risk Management Analyst <br />