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PROTE24 <br />OP ID: MO <br />'4CORO CERTIFICATE OF LIABILITY INSURANCE <br />FDATE(MMYY) <br />10/06/2022021 <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 877-242-9600 <br />Central Insurance Agency, Inc. <br />93 East Main Street <br />CONTACT Central Insurance Agency, Inc <br />NAME <br />PHONE 877-242-9600 FAX 877-243-8995 <br />(A/C, No, Ext): (A/C, No): <br />Smithtown, NY 11787 <br />George Gavaris <br />E-MAIL <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURER A : <br />INSURED <br />Protection America Inc. <br />INSURER B : <br />INSURER C : <br />PPO#120313 <br />21350 Nordhoff St # 104C <br />Chatsworth, CA 91311 <br />INSURER D United Financial Casual <br />11770 <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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />DDL <br />INSD <br />UBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ❑ OCCUR <br />EACH OCCURRENCE <br />$ <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ <br />MED EXP (Any oneperson) <br />$ <br />PERSONAL & ADV INJURY <br />$ <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />X 71 PRO - <br />POLICY LOC <br />OTHER: <br />GENERAL AGGREGATE <br />$ <br />PRODUCTS - COMP/OP AGG <br />$ <br />$ <br />D <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />X <br />X <br />041698620 <br />10/08/2021 <br />04/08/2022 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />1,000,000 <br />$ <br />X <br />BODILY INJURY Perperson) <br />$ <br />BODILY INJURY Per accident <br />$ <br />PROPERTY DAMAGE <br />Per accident) <br />ccident <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <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 />Risk Mowgmenf Division <br /><'j/44■*. 1',.` ReoEwm & APPROVED 13 <br />W1 .I. FiJ_ ']afii �eerr¢ars <br />ACORD 25 (2016/03) © 1988-2015 ACORD CC <br />The ACORD name and logo are registered marks of ACORD <br />