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PKO"IE24 CERTIFICATE OF LIABILITY INSURANCE p Da E 1 4/21/2021121/21 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 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUREII AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER 877.242-9600 Central Insurance Agency, Inc. East Main Street Smithtown, NY 11787 George Gavaris k ACT Central Insurance Agency, Inc HONE 7ao, 7-243-899593 Ext): (wAc No): o GULE INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Employers Assurance Company 25402 NSo RE , rppIon merica Inc. 2135�No� Koff St. 91311 Chatsworth, CA 11 INSURER B : INSURERC: Infinity Select Insurance Company 20260 INSURER 0: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: Rrvminhd MI IkmacR. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY UP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED ES Ea occur $ MED EXP (Any one erson $ PERSONAL B ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT DLOC GENERAL AGGREGATE $ PRODUCTS - COMPADP AGG $ OTHER: C AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X X 504610110722001 10/08/2020 10/0812021 EOMaBBIINdEED SINGLE LIMIT $ 1,000,000 BODILY INJURY Per person)$ BODILY INJURY Per accident $ Pori. %T nt DAMAGE $ AUTOS ONLY AUOTOS ONLY UMBRELLALIAB OCCUR EACH OCCURRENCE Ld AGGREGATE $ EXCESS UAB CLAIMS -MADE DED RETENTION$ A WORKERS ND EMPLOYERS' COMPENSATION ANYPROPRIETCWPARTNER/ XECUTIVE YIN ��FICEftIMEMBER EXCLUDED? ❑Y (Mandatory In NHI If yes, describe under DESCRIPTION OF OPERATIONS below NIA X EIG2562084-02 11/06/2020 11106/2021 X STATUTE OTH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE-EAEMPLOYE $ 110001000 E.L. DISEASE -POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Santa Ana, its officers, employees, agents, and representatives are named as additional insured under the Commercial Auto Liability on this policy pursuant to written contract, agreement, or memorandum of understanding. Waiver of subrogation applies to the Workers Compensation per the attached endorsement. City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 ACORD 25 (2016103) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE yn/ ,e s Rlefa ManagementDMalan r` �L2.� gy1rE6��i /t9' + REVIEWED & APPROVED BY. ©1988-2015 ACORD COe_ `' a�,csY,;,ro,¢ The ACORD name and logo are registered marks of ACORD 1 1' Risk Management Analyst