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Francine R. Digitally signed by Francine R.
<br />Villareal
<br />Villareal Date: 2021.04.1912:3408 07'00'
<br />PACISYM-01 TGARRISON
<br />,d►c CERTIFICATE OF LIABILITY INSURANCE
<br />��
<br />DATE(MM/DD/YYYY)
<br />4/8/2021
<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 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 />CONTACT Laura Hicks
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (A/C, No):
<br />Schweickert & Company Insurance Agents, Brokers & Managers
<br />17300 Red Hill Avenue, Suite 210
<br />Irvine, CA 92614
<br />E-MAIL-ADDRESS: (aura@schweickert.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Great Divide Insurance Company
<br />25224
<br />INSURED
<br />INSURER B : Trl State Insurance Company
<br />INSURER 7
<br />Pacific Symphony
<br />INSURER D 7
<br />17620 Fitch Avenue
<br />Irvine, CA 92614
<br />INSURER E
<br />INSURER F :
<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 />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />CPA7507437-12
<br />12/29/2020
<br />12/29/2021
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />1,000,000
<br />$
<br />X
<br />IVIED EXP (Any oneperson)
<br />$ Excluded
<br />Sexual Misconduct
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY PRO ❑ LOC
<br />JECT
<br />PRODUCTS - COMP/OP AGG
<br />$ 1,000,000
<br />Business Income
<br />$ 500,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />X
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />X
<br />CPA7507437-12
<br />12/29/2020
<br />12/29/2021
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />COMP/COLL DIED.
<br />$ 250
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />CUA7507433-12
<br />12/29/2020
<br />12/29/2021
<br />AGGREGATE
<br />$ 5,000,000
<br />DED X RETENTION $ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y/N
<br />R/EXECUTIVE ❑
<br />ANY PROPRIETOR/ EXCLUDED?
<br />OF EXCLUDED?
<br />(Mandatory in NH)
<br />N/A A
<br />WCA7504355-25
<br />10/1/2020
<br />10/1/2021
<br />X PER R
<br />STATUTE EER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,UOU
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />A
<br />Props,Sets,Wardrobe
<br />12/29/2020
<br />12/29/2021
<br />Special Form
<br />700,000
<br />A
<br />Replacement Cost
<br />=PA707437-12
<br />07437-12
<br />12/29/2020
<br />12/29/2021
<br />Deductible
<br />1,500
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Certificate holder is named as Additional Insured with respects to the operations of the Named Insured. This insurance shall be primary and non-contributing
<br />with respect to insurance or self-insurance maintained by the City. Carrier will issue notice at least 30 days in advance of cancellation. Commercial Auto
<br />Insurance only applies to Non -owned and Hired Autos.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />Y
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL BE DELIVERED IN
<br />Risk Management Division
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, 4th floor
<br />Santa Ana, CA 92702-1988
<br />AUTHORIZED REPRESENTATIVE
<br />� oRaN
<br />Risie
<br />BY.-
<br />REVIEWED &APPROVED BY.
<br />D & APPROVED
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<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD C
<br />The ACORD name and logo are registered marks of ACORD
<br />RlskManagementAnalyst
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