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I IGI ICI I,c n. v„lo, ca, w1e:3Y30JH.1013A4.11 P3'W' <br />ACoO a CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDD/YYYY) <br />9/23/2020 <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 endorsement(s). <br />PRODUCER Asero Insurance Services <br />200 N. Almaden Blvd. 3rd Floor <br />San <br />San Jose, CA 95110 <br />CNAME.ONTACT Asero Insurance services <br />PNCNNO 866-966-8928 A <br />MIC No: 408-271-1802 <br />EMAIL <br />ADDRESS: certsCcDaseroins.com <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />www.asercins.com License No. OA91339 <br />INSURERA: Valley Fore Insurance Company <br />20508 <br />INSURED <br />Mark Thomas & Company, Inc. <br />2833 Junction Avenue, Ste 110 <br />INSURERS: Continental CasualtV Company <br />20443 <br />INSURER Continental Insurance Company <br />35289 <br />INsuRERD: National Fire Insurance Co of Hartford <br />20478 <br />San Jose CA 95134 <br />NSURER E: <br />INSURER F : <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 />ADDL <br />IN IT <br />SUBR <br />WVD, <br />POLICYNUMBER <br />fMPMLICIEFF <br />POLICY UP <br />MMIDO/YYYV <br />LIMITS <br />A <br />r/ <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />3/ <br />,/ <br />6078951385 <br />9/15/2020 <br />9/15/2021 <br />EACH OCCURRENCE <br />$1000000 <br />DAMAGE TO R NTED <br />PREMISES Ea occurrence <br />$1 000 000 <br />MET UP (Any one person) <br />$15 000 <br />Deductible - None <br />PERSONAL &ADV INJURY <br />$1,000000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY ✓� PEO LOC <br />GENERALAGGREGATE <br />$2,000,000 <br />PRODUCTS-COMP/OPAGG <br />$2000000 <br />$ <br />OTHER: <br />B <br />AUTOMOBILE <br />LIABILITY <br />✓ <br />✓ <br />6078951371 <br />9/15/2020 <br />9/15/2021 <br />Ee Mac EDtSINGLE LIMIT <br />$1 000 OQQ <br />1/ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY ✓ AUTOS ONLY <br />BODILY INJURY (Per accident) <br />$ <br />✓ <br />PROPERTY -DAMAGE <br />Per becidenl <br />$ <br />Com /Coll Ded: 1 000 <br />$ <br />C <br />✓ <br />UMBRELLA LIAB <br />OCCUR <br />6078951399 <br />9/15/2020 <br />9/15/2021 <br />EACH OCCURRENCE <br />$5000,000 <br />AGGREGATE <br />$5 000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I I RETENTION SO <br />Deductible - None <br />$ <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANYPROPRIETORTARTNEWEXOFFICER/MEM EREXCLUDED'l ECUTIVE ❑ <br />N/A <br />✓ <br />6078951418 <br />9/15/2020 <br />9/15/2021 <br />✓ I STATUTE I I OEgH <br />E.L. EACH ACCIDENT <br />$1000000 <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />(Mandatary in NH) <br />N yes, describe under <br />E.L. DISEASE -POLICY LIMIT <br />$1 000 000 <br />DESCRIPTION OF OPERATIONS below <br />A <br />A <br />Leased,Bormwed Or Rented <br />Equipment <br />Restoration of Media Coverage <br />(Valuable Papers) <br />6078951385 <br />6078951385 <br />9/15/2020 <br />9/15/2020 <br />9/15/2021 <br />9/15/2021 <br />Per Item Limit: $100,000 <br />Per Occurrence Limit: $100,000 <br />Limit/ Deductible: $1,000,000/$5,000 <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Re: Job #IR-18107 - On -Call Design Engineering Support Services (Agreement #A-2018-159-07) <br />City of Santa Ana, it's Officers, Employees, Agents, and Representative are named as Additional Insured. <br />Note: 30 Days Notice of Cancellation will be given except 10 days for non-payment of premium. <br />The Workers Compensation / Employers Liability Deductible is none. <br />Job #IR-18107 <br />Cit of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />y 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 _ <br />Joe Longwello REVIEWED&APPROVED BY: <br />©1988-2015 ACORD C `I I ' FML.,,:� R. vdt. zA( <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Rrsk Management Analyst <br />50914802 1 MAWCT-1 120-21 Maatei Certificate I Prabhjot Xaua 1 9/23/2020 2:39:23 PM (PDT) I Page 1 of 11 <br />