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<br />llallagnm trvan�m.
<br />Francine R. Villareal Vila=a
<br />D.I.: ro IPAzz isneie .1 W
<br />INLAMOV-02
<br />KGO
<br />DAT420/2120/2D�I1
<br />021
<br />CERTIFICATE OF LIABILITY INSURANCE
<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 endorsements .
<br />PRODUCER License # 0757776
<br />CONEACT Gall Schrenk
<br />HUB International Insurance Services Inc.
<br />PO Bside,ox C
<br />Riverside, CA 92517
<br />PHONE INC,o,Eel: (951) 779-8763 FAX
<br />N°I.
<br />E-M I Gaii.Schrenk@hubinternational.com
<br />Ao�REs ;
<br />INSURERS AFFORDING COVERAGE
<br />NAICM
<br />INSURER A: TransGUard Insurance Company of America
<br />28886
<br />INSURED
<br />INSURER B :
<br />INSURER C:
<br />Inland Moving & Storage, Inc.
<br />INSURER D
<br />P.O. BOX 28
<br />Riverside, CA 92502
<br />INSURERE:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR-
<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 RESPECTTO 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 />ADDLSUBR Man
<br />WAD
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPLTR
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADEOCCUR
<br />PD Ded: $1,000
<br />X
<br />TCP011035717
<br />4M/2021
<br />41112022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGETO RENTED ce
<br />PREMISS
<br />$ 100,000
<br />X
<br />MED EXP (Anyone ps,syl
<br />$ 5,000
<br />PERSONAL S ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER.
<br />POLICY [X1 jPCT1:1 LOG
<br />GENERAL AGGREGATE
<br />It 2,000,000
<br />GEN'L
<br />PRODUCTS - COMP/OP AGG
<br />g 2,000,000
<br />Max Agg all job
<br />$ 3,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMaBINEeD SINGLE LIMIT
<br />$. 1000000
<br />BODILY INJURY Per arson
<br />$
<br />ANYAUTO
<br />OWNED X SCHEDULED
<br />AUTOS ONLY AUU�T�,NO.pSSWNEp
<br />X
<br />TCP011035717
<br />4/112021
<br />4/112022
<br />BODILY INJURY Per accident
<br />$
<br />PeOracECHitlent AMAGE
<br />$
<br />X
<br />X
<br />AUTOS ONLY X AUrOS ONLY
<br />Liability Ded. $1k
<br />8
<br />A
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />EXCESS UAB
<br />CLAIMS -MADE
<br />TC0000018211
<br />4/112021
<br />4/112022
<br />RED X I RETENTION$ 10,000
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIEfOR/PARTNERIEXECUTIVE ❑
<br />OFFICERNEMBT�q EXCLUDED?
<br />(Mandatory in NHI,
<br />If yes, describe under
<br />NIA
<br />PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />E.L. DISEASE - EA EMPLOYE
<br />---
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />I $
<br />A
<br />Cargo Liability
<br />TCP011035717
<br />41112021
<br />4/1/2022
<br />jAny One LOSS
<br />1 100,000
<br />A
<br />Cargo Liab. DED: $1K
<br />TCP011035717
<br />4/112021
<br />4/1/2022
<br />Aggregate In Transit
<br />200,000
<br />DESCRIPTION OF OPERATIONS ILOCATIONSIVEHICLES ACORD1111, Additional Remarks Schedule,ma beattached Umorespaceiare,idad)
<br />Insured Location 1625 Iowa Ave, Riverside CA 2607. Umbrella policy follows underlying policies GL & Auto
<br />City of Santa Ana, officers, agents, employees, and volunteers are Additional Insured with regard to General Liability when required by written contract per
<br />the
<br />attached endorsement form 064058 0418. Primary & Non -Contributory wording applies with regard to General Liability when required by written contract per
<br />the attached endorsement form CG2001 0413. Additional Insured with regard to Autol Liability when required by written contract per the attached
<br />endorsement form 014108 0418.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CityOf 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 92701 AUTHORIZED REPRESENTATIVE
<br />n �,i? RhkM &APPRcfv elwt
<br />An' REVIEwED6FVPRov®Br.
<br />ACORD 25 (2016/03) ©1988-2015 ACORD C ,�
<br />Risk Management Analyst
<br />The ACORD name and logo are registered marks Of ACORD
<br />
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