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ACC)Ra CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDIYYYY) <br />11/03/2020 <br />.THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 endorsament(s). <br />PRODUCER <br />CONTACT Heather Verdul <br />NAME: <br />Mike Smith, New Jersey Lic.P&C !Surplus#99401fi5 <br />pN�NNO (201)847-9175 a?c (201)847-9174 <br />Ezt; Ne: <br />E-MAIL hverdui@jaxislns.com <br />ADDRESS: <br />Axis Insurance Services, LLC <br />795 Franklin Avenue, Suite 210 <br />INSURER(SI AFFORDING COVERAGE <br />NAIC k <br />INSIIRERA: Allied World Insurance Cc <br />22730 <br />Franklin Lakes NJ 07417 <br />INSURED <br />INSURER B: <br />INSURER C : <br />Keenan & Associates <br />INSURER D: <br />2355 Crenshaw Blvd, Suite 200 <br />INSURER E <br />Torrance CA 90501 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: I0760 EO20121 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 />INSR <br />WVD <br />POLICY NUMBER <br />POLICY F <br />MMIDDIYYYY) <br />POLICY EXP <br />(MMIDDrYNNY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 15,000,000 <br />CLAIMS -MADE DOCCUR <br />DAMAGE TO RENTED <br />PREMISES Es occurrence <br />S <br />MED EXP(Any oneperson) <br />$ <br />Limits are Per Claim <br />Errors & Omissions <br />PERSONAL &AOV INJURY <br />$ <br />A <br />0307-7977 <br />10/01/2020 <br />10101/2021 <br />GEN'L AGGREGATE LI MIT APPLIES PER: <br />GENERALAGGREGATE <br />$ 15,000,000 <br />POLICY ❑ PRO- <br />JECTLOG <br />PRODUCTS-COMPIOPAGG <br />$ <br />OTHER: Retro 3/31/2017 <br />Retention Per Claim <br />$ 250,000 <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANYAUTO <br />I <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />q <br />PROPERTY DAMAGE <br />Per ddent <br />$ <br />8 <br />1 <br />UMBRELLALIAB <br />OCCUR <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />S <br />EXCESS LIAR <br />CLAIMS -MADE <br />DED <br />RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />I PER OH - <br />AND EMPLOYERS' LIABILITY YIN <br />STATUTE 11 1 ER <br />E.L. EACH ACCIDENT <br />$ <br />ANY PROPRIETORIPARTNERIEXECUTIVE ❑ <br />OFFICERIMEMBER EXCLUDED? <br />NIA <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be atfached if more space is required) <br />Professional Services include Insurance AgenUBroker, Claims Administration, HR Consultant, Benefits Administrator, Enrollment Services and Third <br />Party <br />Administrator. <br />The defnilion of an Insured in this policy includes bath the company and individuals in their roles as Principals, employees, sub -agents, sub -brokers <br />.and independent contractors of the Insured. These individuals are automatically insured for covered Professional Services when they are performed on <br />behalf of and at the direction of the Insured. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza (M-24) <br />Santa Ana CA 92702 .� ,yx-w �stp ! RkIrM¢nagannriLDivIslan <br />zry t M•?: REVIEWED, &APPROVED aY: <br />©1966-2015 ACOR " <br />'' rMGW�-K R. V:.U4M1td� <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Risk Management Analyst <br />