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CATHENT-01 APETRONIO
<br />AIR® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 21 v)
<br />3/31/2021
<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 License # OF76001
<br />CONMTACT E:
<br />C7K North American Insurance Services, LLC I INSURICA
<br />1240 North Lakeview Avenue, #240
<br />Anaheim, CA 92807
<br />PHONE FAX
<br />(uc, No, E#: (714) 779-2000 (aic, uo):(714) 779-4129
<br />E-ML
<br />AO AIEBB:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC9
<br />INSURER A: Everest National Insurance Company
<br />10120
<br />INSURED
<br />INSURER B:Everest Indemnity Insurance Co.
<br />10851
<br />INSURER C. Security National Insurance Company
<br />19879
<br />CathyJon Enterprises, Inc.
<br />INSURER D
<br />2120 Main Street, Ste 250
<br />Huntington Beach, CA 92648
<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 />INBR
<br />OF INSURANCE
<br />ADDTYPE
<br />INSD
<br />MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPLTR
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I� OCCUR
<br />X
<br />91ML002325211
<br />419/2021
<br />419/2022
<br />EACH OCCURRENCE
<br />$ 1 0000,000
<br />PREMI ETO a occurrence)
<br />$ 200,000
<br />MEO EXP JAny oneperson)
<br />$ 10,000
<br />PERSONAL S ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIM n APPLIES PER:
<br />POLICY jD LOG
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />X
<br />PRODUCTS - COMP/OP AGG
<br />$ 21000,000
<br />IABUSE
<br />3 1,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,ggg Ogg
<br />$
<br />BODILY INJURY (Panperson)
<br />$
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUr0.pp5WW
<br />X
<br />91ML002325211
<br />419/2021
<br />41912022
<br />BODILY INJURY (Per accident
<br />X
<br />AUTOS ONLY X AU'fOSOALD
<br />Pe�acatlen �AMAGE
<br />$
<br />B
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />i
<br />AGGREGATE
<br />$ 2,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />91CUND0312211
<br />4/9/2021
<br />4/9/2022
<br />DED X I RETENTION$ D
<br />C
<br />WORKERS
<br />ND EMPLOYER$' LIIABILIITY
<br />ANY PROPRIETORIPARTNER/EXECUnVE YIN
<br />(tdandERJME NH)EXCLUDED? �
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />SWC1334967
<br />4/912021
<br />41912022
<br />X STATUTE ORH-
<br />EL EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,DDD,DDD
<br />E.L. DISEASE -POLICY LIMIT
<br />1,000,000
<br />A
<br />Crime
<br />91CROO1085211
<br />41912011
<br />41912022
<br />$5,000 Deductible
<br />1,000,000
<br />A
<br />Professional Liab
<br />91MLOO2325211
<br />41912021
<br />419/2022
<br />$2M/$4M Ded. $2500
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />Cyber Liability Insurance
<br />Policy: HCXCYSP221566920
<br />Carrier: Hiscox Insurance Company
<br />Limits: $2,000,000 Deductible $5,000
<br />Term Effective Date: 10/2/2020 to 10/212021
<br />SEE ATTACHED ACORD 101
<br />City of Santa Ana
<br />Human Resources Department
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92701
<br />ACORD 25 (2016/03)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />EwEo & APPROVED
<br />BY.
<br />ion
<br />REVIEv/ED&APPRDVm BY:
<br />9)1988-2015 ACORD C11 I 0Emmm, f4M�A44 R' VWA ed
<br />The ACORD name and logo are registered marks of ACORD I 1 �- auk Management AOalyst
<br />
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