|
Digit
<br />Tori Pierson Datea21022..03.22915:25:45e0700'
<br />ACCORD® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />1
<br />`l
<br />3/27/2022
<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 />CONTACT
<br />NAME: Gallagher Select Client Service
<br />Arthur J. Gallagher & Co.
<br />PHONE FAX
<br />Insurance Brokers of CA. Inc, LIC # 0726293
<br />A/C No Ext : 833-391-6524 A/c, No): 702-854-2444
<br />ADDRESS: selectclientservice@ajg.com
<br />18201 Von Karman Ave Suite 200
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />Irvine CA 92612
<br />INSURERA: Philadelphia Indemnity Insurance Company
<br />18058
<br />INSURED AEFSYST-01
<br />INSURER B: Continental Casualty Company
<br />20443
<br />AEF Systems Consulting, Inc.
<br />8502 E. Chapman Ave #376
<br />INSURERC: Citizens Insurance Company of America
<br />31534
<br />INSURERD:
<br />Orange CA 92869
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 1924711993 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 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 />INSD
<br />SUBR
<br />WVD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />B6045340517
<br />8/23/2021
<br />8/23/2022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY ❑PRO ❑
<br />JECT LOC
<br />X
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />B6045340517
<br />8/23/2021
<br />8/23/2022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />B
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />B6045340520
<br />8/23/2021
<br />8/23/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ 1 n nnn
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />WBCH413981
<br />2/1/2022
<br />2/1/2023
<br />X PER OTH-
<br />STATUTE ER
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />E&O
<br />PHSD1663506
<br />9/9/2021
<br />9/9/2022
<br />Limit
<br />$1,000,000
<br />Aggregate
<br />$2,000,000
<br />Retention
<br />$2,500
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />RE: Public works and maintenance.
<br />The City of Santa Ana, its officers, officials, employees, volunteers and representatives are Additional Insured as respects General liability policy, pursuant to
<br />and subject to the policy's terms, definitions, conditions and exclusions. The insurance provided in the general liability policy is primary and any other insurance
<br />shall be excess only, and not contributing. Waiver of Subrogation applies to additional insureds, as respects General liability policy, pursuant to and subject to
<br />the policy's terms, definitions, conditions and exclusions.
<br />CERTIFICATE HOLDER CANCELLATION
<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 />Risk Management Division
<br />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701 &APPRavEDBr.
<br />USA at p oo
<br />© 1988-2015 ACORD C(
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
|