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ACC)RO CERTIFICATE OF LIABILITY INSURANCE �� DATE (MIA DOMY 11/03/2020 .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 INSURER(S), 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 endorsement(s). PRODUCER CONTACT Heather Verdui NAME: Mike Smith, New Jersey Lic. P&C /Surplus p 9940165 Axis Insurance Services, LLC PHONE (2p1)847-9175 FAX (201)847-9174 A/C INExl : A/C. No EMAIL hverd!iQ,' isins.com ADORESs: 795 Franklin Avenue, Suite 210 Franklin Lakes NJ 07417 INSURER(S) AFFORDING COVERAGE NAIC M INSURERA: Allied Word Insurance Co 22730 INSURED INSURER B : INSURER C : Keenan & Associates INSURER D : 2355 Crenshaw Blvd, Suite 200 INSURER E: Torrance CA 90501 INSURER F: CUVERAGE5 CERTIFICATE NUMBER: !U/bU EUZU21 RFVIRION NI IMRPP. 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSR MID POLICY NUMBER POLICY EFF MWDDNYYY POLICY EXI' MMIDDIYI'YY LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 15.000,000 PREMISES Ea pccuoence $ CLAIMS -MADE OCCUR Limits are Per Claim MED EXP (Any one pemon) $ Emors&Omissions PERSONAL B ADV INJURY $ A 0307-7977 10/01/2020 10/01/2021 GEN'L AGGREGATE LIMITAPPLIES PER: POLICY 0 JECT PRO- ❑ LOG GENERALAGGREGATE $ 15,000,000 PRODUCTS - COMPIOP AGO $ OTHER: Retro 3/31/2017 Retention Per Claim s 250,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS 1 BODILY INJURY (Per accidenQ $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY P PROPERTY DAMAGE Per accident $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE s AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I RETENTION $ WORKERS COMPENSATION PER OTH- ANDEMPLOYERSLIABILITY YIN STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNERIF_XECUTIVE ❑ OFFICER(MEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes. describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Professional Services include Insurance AgenUBroker, Claims Administration, HR Consultant, Benefits Administrator, Enrollment Services and Third Party Administrator. The definition of an Insured in this policy includes both the company and individuals in their roles as Principals, employees, sub -agents, sub -brokers and independent contractors of the Insured. These individuals are automatically insured for covered Professional Services when they are performed on behalf of and at the direction of the Insured. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza (M-24) AUTHORIZED REPRESENTATIVE Santa Ana CA 92702 ( Irk. �.l.l RW$M�agonmtD[viaimt REVIEWED&APPRCNED BV: ©1988-2015 ACOR �,�,ytiq R. V:.UMuI ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD pick Management Anaryrt