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<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDD/YYYY)
<br />01/13/2021
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR
<br />ALTERTIIG COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(ST AUTHORIZED REPRESENTATIVE OR
<br />PRODUCER, AND THE CERTIFICATE HOLDER
<br />IMPORTANT: If the ttrtlBenle holder Is on ADDITIONAL INSURED, (lie polleyDes) must have ADDITIONAL INSURED provision& or he endorsed. If SUBROGATION IS WAIVED, subject to the terms And commands
<br />,,,hire an enderrement A statement on this certNcnle does ram enter rlEhla to the eerBOcate holds, In Its. of such endonemenl(s).
<br />of the policy, certain policies may
<br />PRODUCER
<br />CONTACT NAME:
<br />FounderShleld, LLC
<br />PHONE (A/C No, FAQ: 646-854-1058
<br />122 W 26th Street, 2nd Floor
<br />New York, Now York, 10001
<br />E-MAIL ADDRESS: GIRSfnank ehlel Leam
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC4
<br />INSURER A: ]HARTFORD UNDERWRITERS INS CO (HARTFORD)
<br />30104
<br />INSURED
<br />INSURER III ILLINOIS UNION INSURANCE CO
<br />27960
<br />INSURER C I AXIS INSURANCE COMPANY
<br />37273
<br />Deneme
<br />INSURER D
<br />3423 Piedmont Rd NE
<br />a11nn1n, Ceor%k, 30305
<br />INSURER E :
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OFINSUMNCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDAROVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT,TERM OR
<br />CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCEMFORDED BY THE POLICIES DESCRIBED HEREIN IS SURJECTTO
<br />ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />INSR
<br />TYPE OF INSURANCE
<br />ADDL
<br />BOOR
<br />POLICYNUMBER
<br />POLICY FEE
<br />POLICYEXP
<br />LIMITS
<br />LIFE
<br />INSD
<br />WVD
<br />(MM/DD/YYYY)
<br />(MMMD/YYYY)
<br />COMMERCIAL GENELIABILITY
<br />EACH OCCURRENCE
<br />$1,000,000.00
<br />fAL
<br />yR
<br />(,E CLAIMS MADE jVj OCCUR
<br />DAMAGE TO RENTED
<br />$I,UDD,DOO.0D
<br />PREMISES (Ea occurrence)
<br />MED EXP(Any one person)
<br />$1 000.00
<br />A
<br />CiEN'L AGGREGATE LIMIT APrPLIES PER:
<br />��
<br />RI
<br />�
<br />IOSBAAJIMSR
<br />OIJ1812021
<br />01/18/2022
<br />PERSONAL& ADV INJURY
<br />$1,000,D00.00 '
<br />q�„q POLICY,,,(PROJECT j>f,I LOC
<br />GENERALAGGREGATE
<br />$2,ODQ000.00
<br />PRODUCTS-COMP/OP AGG
<br />$2,000,D00.00
<br />t-S OTHER
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />$1,000,000.00
<br />I.. i ANY AUTO
<br />E. Accident)
<br />BODILY INJURY (Per person)
<br />[]OWNEDAUTOS
<br />A
<br />ECHEDULEO
<br />I'•'
<br />1056AAS1M5R
<br />U1/10/2021
<br />01/18/2022
<br />BODILY INJURY (Per
<br />ONLY
<br />'Vn #'NON -OWNED AUTOS
<br />i HIRED AUTOS ONLY
<br />Accident)
<br />PROPERTY DAMAGE (Per
<br />:
<br />ONLY
<br />AeeidenQ
<br />I 3 UMBRELLA LIAR � E%CESB LIAR
<br />Each need ... be.
<br />$2,000,000.00
<br />B
<br />^s -�r
<br />n'-J
<br />-
<br />G7250391DO01
<br />MAW2021
<br />01/18/2022
<br />AgqggrcgMe
<br />$3,000,000.00
<br />r,u)OCCUR � i CLAIMS -MADE
<br />-
<br />WORKERS COMPENSATION AND E
<br />EMPLOYERS' LIABILITY
<br />g
<br />[]PER STATUTE
<br />ANYP ROPRIETORryARTNERAMUCU TIC YIN
<br />OTHER
<br />OFFICER/MIthei EXCLUDED? N
<br />E.L,EACHACCIDEN
<br />(MAmlrtoryin NH)
<br />If yes, describe under DESCRIPTION OF OPERATIONS below
<br />N/A
<br />q,,,,i
<br />E.L. DISEASE - RA
<br />EMPLOYEE
<br />E.L. DISEASE -POLICY
<br />LIMIT
<br />C
<br />CyUer LInUllity,Mudle Llability,Ertare&Omissions
<br />"J.
<br />LA
<br />ITTI-200295-01
<br />01/18/2021
<br />011IW2022
<br />13,000,000 per act $3,000,000 In add
<br />C
<br />dnl
<br />SaEnginceeing
<br />r
<br />c. �'
<br />ITTIC400275-01
<br />01/18/2021
<br />0I/I8/2022
<br />$IDO,DUDperoce $100,000ioagg
<br />A
<br />Property,
<br />s
<br />i-3
<br />IL j
<br />IOSBAAJIMSR
<br />01/18/2021
<br />0111M022
<br />112000.00 BIT $1,000 deductible
<br />(
<br />c, �l
<br />i
<br />w
<br />IIESCRIPI'IIIN OFOPERATIONS/LOCATIONS/ VEHICLES (ACOIID IOL Addillonul Remarks Sebetlule, may be uHueM1ed If more spnee h &¢,aired)
<br />CiO.fSmtA Arm,mycers,A,.B,rmployees, and volinkms mmnamed.smidllleamlly lmnredon this pnlleypinsimm in,vdnen onllnr,ogreemenLo, onentmndmm mfunderslm:dlnr. Such Insurance ns isanonled by this polleyshull he primary, and
<br />any Imurnnee carded by Clommll he Ateen and nm:rn,tltlbulory. CefMente of Insurance skull provide 1hhM1y (30) day prior wrlllen notice of enneellation.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE
<br />City of Santa Ana THEREOF, NOTICE WILL HE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE
<br />®1988-201(
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />�B Risk Marugelnmtl)nieloD
<br />IN REmEwED&APMtoVm BY:
<br />-"'�^' Risk Managelneld Analyst
<br />
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