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t-rancine H. Villareal Villareal
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<br />'4�M" CERTIFICATE OF LIABILITY INSURANCE
<br />ni irka
<br />DATDIYYYY)
<br />12/8/2/8/2020
<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 endorsements).
<br />PRODUCER
<br />Alliant Insurance Services, Inc.
<br />575 Market St Ste 3600
<br />San Francisco, CA 94105
<br />CONTACT Melissa Hill
<br />NAME:
<br />PHONEo, FAX
<br />A/c, NEXt): (415) 946-7500 A/C, No:
<br />AE-p"lMLss.Melissa.Hlll@,Alllant.com
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Travelers Property Casualty Company of America
<br />25674
<br />INSURED
<br />INSURER B:Travelers Indemnity Company of America
<br />25666
<br />INSURERC:Arch Insurance Company
<br />11150
<br />CSG Consultants, Inc.
<br />INsuRERD:
<br />550 Pilgrim Drive
<br />Foster City, CA 94404
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CFRTIFICATF NIIMRFR, RF11Lclnkl nulMnco.
<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 />TYPE OF INSURANCE
<br />ADDL
<br />INSID
<br />SUBR
<br />POLICYNUMBER
<br />POLICY EFF
<br />IMMIDDiYYYY)LIMITS
<br />POLICY EXP
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />660.SR143841-TIL-20
<br />12/412020
<br />12/412021
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea Dc rence
<br />1000000
<br />MED EXP (Any one arson
<br />$ 10,000
<br />PERSONAL&ADV INJURY
<br />IS 1,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY �X JECT �LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP/OP AGE
<br />$ 2,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED t SINGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJURY Per emcn
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />X
<br />810.5R143576-20-43-G
<br />12/4/2020
<br />12/4/2021
<br />Ix
<br />BODILY INJURY Per accident
<br />$
<br />d20PAMAGEA
<br />cmdent$BPPOwnedAutos
<br />H NONOWNED
<br />S ONLY AUTOS ONLYer
<br />Comp/CollDed.
<br />$ 2,000
<br />B
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />ZUP-61 N34906.20-NF
<br />1214/2020
<br />12/4/2021
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND MqPL YERSpIPA LIABILITY
<br />N
<br />ANY EMPLOYERS'
<br />(N1a.ICEPI'ME NH)EXCLUDED? ®
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />UB-5R147157-20-43-G
<br />1214/2020
<br />12/412021
<br />X STATUE 'ER'_
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />1,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />1,000,000
<br />C
<br />Professional Liab.
<br />PAAEP0008805
<br />12/4/2020
<br />12/4/2021
<br />$5,000,000 Agg; Ded:
<br />50,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES ACORD 101, Additlonal Remarks Schedule, me be aaached If more space Is required)
<br />RE: Consultant Agreement for Municipal Plan heck Services City of Santa Ana, ofliicers, agents, employees, and volunteers are named as additionally
<br />insured on this policy pursuant to written contract, agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be
<br />primary, and any insurance carried by City shall be excess and noncontributory per general liability and automobile liability per attached endorsements. 30
<br />Day Notice of Cancellation on Professional Liability per attached.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92701
<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 />REVIEWED Sr APPROVED BY.
<br />ACORD 25 (2016/03)
<br />©1988-2015 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />Rink iNOnac]emeryt Analyst
<br />
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