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FI CtI R.II IC R. V I I IQI CCII Dete:202102.2211:51:29-08-00'
<br />ARDURRA-01 KGODWIN
<br />'Ai a" CERTIFICATE OF LIABILITY INSURANCE
<br />DATDIYYVY)
<br />21161218/2021
<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
<br />Ames & Gough
<br />8300 Greensboro Drive
<br />Suite 980
<br />CNAONTAE•CT
<br />PHONE FAX
<br />A/C,Na, Ext: (703) 827-2277 (Alc, No:(703 827-2279
<br />FJ-MAIL admln@amesgough.com
<br />DOREss:
<br />VA 22102
<br />INSURERS AFFORDING COVERAGE
<br />NAIC d
<br />INSURER A: Valley Fore Insurance Company A XV
<br />20508
<br />INSURED
<br />INSURER B : National Fire Insurance Company Of Hartford AM)
<br />20478
<br />INSURER C: Continental Insurance Company A XV
<br />35289
<br />AndersonPenna Partners, Inc.
<br />INSURER D: Berkshire HathawaySpecialty Insurance Company
<br />22276
<br />3737 Birch Street, Suite 250
<br />Newport Beach, CA 92660
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER- RFVICInN 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 />TYPE OF INSURANCE
<br />ADp
<br />SUBR WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPLTR
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />Contractual Liab.
<br />X
<br />X
<br />6075640222
<br />1/1/2021
<br />1/1/2022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PDAEMGETOEa ccurrreenc
<br />1,000,000
<br />$ 15,000
<br />X
<br />MED EXP (Any oneperson)
<br />PERSONAL&ADV INJURY
<br />$ 1,000,000
<br />GENT
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY [X] YER& LOD
<br />GENERAL AGGREGATE
<br />2,000,000
<br />PRODUCTS-COMP/OP AGO
<br />$ 2,000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(Ea accident
<br />$ 1,000000
<br />X
<br />BODILY INJURY Perperson)
<br />ANY AUTO
<br />AUgTEO�S ONLY SCHEDULED
<br />SSWULEOp
<br />X
<br />X
<br />6075640236
<br />1/1/2021
<br />111/2022
<br />BODILY INJURY Per accident
<br />$
<br />PPare kept AMAGE
<br />$
<br />AUTOS ONLY A�TNOS ONN<LV
<br />C
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 15,000,000
<br />AGGREGATE
<br />$ 15,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />6075640270
<br />1/112021
<br />111/2022
<br />DED I X I RETENTION$ 10,000
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICEWWMMEMBWp EXCLUDED? �N
<br />(Man tlatoryln NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />X
<br />6075640267
<br />1/112021
<br />1/112022
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />D
<br />Professional Liab.
<br />47-EPP-306878-03
<br />111/2021
<br />1/1/2022
<br />Per ClaimlAggregate
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />RE: ALL OPERATIONS OF THE NAMED INS[
<br />The City of Santa Ana, Its Officers, Employees, Agents, and Representatives are included as additional Insured with respect to General Liability and
<br />Automobile Liability when required by written contract. General Liability is primary and non-contributory over any existing insurance and limited to liability
<br />arising out of the operations of the named insured and when required by written contract. General Liability, Automobile Liability and Workers Compensation
<br />policies include a waiver of subrogation In favor of the additional insureds where permissible by state law and when required by written contract. 30-day
<br />Notice of Cancellation will be issued for the General Liability, Automobile Liability, Workers Compensation and Professional Liability policies in accordance
<br />with policy terms and conditions.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cityof Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE lilahMai1a8a1tettEDlYis(on
<br />RLVILIUEO&APPROVED BY:
<br />ACORD 25 (2016/03) ©1988.2015 ACORD C I 1 x �1�°'
<br />The ACORD name and logo are registered marks of ACORD
<br />Rink lvtanagement Analyst
<br />
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