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EDGEWORTH INTEGRATION, LLC
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Last modified
3/4/2024 7:53:20 AM
Creation date
5/17/2021 4:03:45 PM
Metadata
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Contracts
Company Name
EDGEWORTH INTEGRATION, LLC
Contract #
A-2021-052
Agency
Parks, Recreation, & Community Services
Council Approval Date
4/20/2021
Expiration Date
12/21/2024
Destruction Year
2029
Notes
For Insurance Exp. Date see Notice of Compliance
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Digitally signed by Francine R. <br />Francine R. Villareal Villareal <br />Date: 2021.06.03 17:34:18 -0700' <br />/ <br />A� " CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <br />4/26/2021 <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 />The Signature B&B Companies <br />501 Franklin Avenue <br />Suite 218 <br />CONTACT <br />NAME: Elizabeth Erdtmann <br />PHONE FAx <br />A/C No Ext : 516-764-1100 A/C, No): 516E-M-764-1019 <br />ADDRESS: EErdtmannCPCU@sbbinsure.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />Garden City NY 11530 <br />INSURERA: Allied World Assurance Co. <br />19489 <br />License#: BR-1117267 <br />INSURED EDGESEC-01 <br />Edgeworth Integration LLC <br />2360 Shasta Way, Unit F <br />INSURERB: Everest National Ins. Co. <br />10120 <br />INSURERC: <br />INSURERD: <br />Simi Valley CA 93065 <br />INSURER E <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER:871382415 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 />POLICYNUMBER <br />POLICY EFF <br />MM/DD <br />POLICY EXP <br />MM/DD <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />Y <br />Y <br />52002370-02 <br />11/5/2020 <br />11/5/2021 <br />EACH OCCURRENCE <br />$1,000,000 <br />CLAIMS -MADE OCCUR <br />DAMAGES(RENTED <br />PREMISES Ea occurrence) <br />ccurrence)$ <br />100,000 <br />X <br />MED EXP (Any one person) <br />$ 10,000 <br />Abuse-$1,000,000 <br />PERSONAL &ADV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 3,000,000 <br />PRO - <br />POLICY � ECT1:1 LOC <br />PRODUCTS - COMP/OP AGG <br />$ 3,000,000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />Y <br />Y <br />52020091-02 <br />11/5/2020 <br />11/5/2021 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$1,000,000 <br />X <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <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 />A <br />UMBRELLA LAB <br />OCCUR <br />Y <br />52010868-02 <br />11/5/2020 <br />11/5/2021 <br />EACH OCCURRENCE <br />$9,000,000 <br />X <br />X <br />AGGREGATE <br />$ 9,000,000 <br />EXCESS LAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />Y <br />5300004435-201 <br />9/1/2020 <br />9/1/2021 <br />X PER OTH- <br />STATUTE ER <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />OFFICER/MEMBER EXCLUDED? FN] <br />N/A <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />City of Santa Ana, its officers, officials, employees and volunteers are included as Additional Insureds, with respects to General Liability, as required by written <br />contract executed prior to loss. Coverage is primary and non-contributory and waiver of subrogation applies as required by written contract. 30 Day Notice of <br />Cancellation will be provided. <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, <br />NOTICE WILL <br />BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Risk Management Division <br />20 Civic Center Plaza, 4th Floor <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92702-1988 <br />,�oRaN� <br />Risk MallagementDiviaian <br />3 <br />REVIEWED & APPROVED BY.- <br />@ 1988-2015 ACORD C <br />Y <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />Risk Management Analyst <br />
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