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ACORO® rrdnclDe:.,PATE
<br />CERTIFICATE OF LIABILITY INSURANCE Villareal "°°
<br />(MM/DONYYY)
<br />��
<br />06/02/2021
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER LICENSE NO. 0637431
<br />CONTACT NAME: pATRICK MCRAE
<br />PATRICK MCRAE INSURANCE SERVICES
<br />PHONN E (714) 779-6999 a No; (714) 779-6903
<br />aooaess: certrequest@mcraeinsurance.insure
<br />1265 N. MANASSERO ST. SUITE 303
<br />INSURERS AFFORDING COVEUINSURANCE
<br />ANAHEIM HILLS, CA 92807
<br />INSURER A: NAVIGATORS SPECIALTY
<br />INSURED
<br />INSURER B:INSURANCE COMPANY O
<br />INSURERC: INTEGON NATIONAL INSUCROSSTOWN
<br />A29742
<br />ELECTRICAL & DATA, INC.
<br />INSURERD: ATLANTIC SPECIALTY INS5454
<br />DIAZ STREET
<br />INSURER E: GREAT AMERICAN INSUR
<br />IRWINDALE CA 91706
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: RFVICInN NIIMRFR•
<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 INSURANCEivatm
<br />ADDLSUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />fMMA)DNYYY1
<br />POLICY EXP
<br />iMMfDDrfYYY)LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑X OCCUR
<br />XCU -
<br />X
<br />X
<br />LA20CGLZ04TP71C
<br />DEDUCTIBLE $5,000 PER
<br />OCCURENCE
<br />09103/202009/03/2021
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Eanccurrence
<br />$ 100,000
<br />X
<br />MED EXP (Any one person)
<br />$ 5,000
<br />X
<br />OCP
<br />PERSONAL&ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY JEC LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />EBL
<br />$ 1,000,000
<br />OTHER
<br />I
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />2005675448
<br />11/05/202011/0512021
<br />OMBINEDISINGLE LIMIT
<br />JEa1,000,000
<br />$
<br />rson)
<br />BODILY INJU RY(Per PeALL
<br />$ _
<br />ANY AUTO
<br />AUTO�ED X AUTOSULEOBODILY
<br />S
<br />Ix
<br />INJURY(Per accident)
<br />$HIRED
<br />AUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />Per accitlent
<br />$
<br />E
<br />UMBRELLA LIAR
<br />EXCESSLIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />TUE 2572052 03
<br />UNDERLYING LIMITS:
<br />GL; AL; EL POLICIES
<br />06/03/2021
<br />09/03/2022
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />X
<br />AGGREGATE
<br />$ 10,000,002
<br />X
<br />DED RETENTIONS O
<br />$ _
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY
<br />OFFICEWMEIMBER PROPREXCLUDED?ECUTIVE 1N/A
<br />x
<br />WVE 5030354-06
<br />06/03/202106/03/2022
<br />X STATUTE ERH
<br />E.L EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory In NH)
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />D
<br />PROPERTY & CONTRACTORS
<br />EQUIPMENT
<br />710039414
<br />$1,000 DEDUCTIBLE
<br />COV. INCL THEFT
<br />05/10/2021
<br />05/10/2022
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<br />iia eom :m ppn ramvu,
<br />em,�e�
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES ACORD 101, Additional Remarks Schedule, ma be coached if more space Is mqulmd
<br />THE CITY OF SANTA ANA RISK MANAGEMENT DI ISION, ALONG WITH THEIR OIRECTOM OFFICERS, AND EMPLOYES ARE NAMED AS ADDITIONAL INSURED
<br />WITH RESPECTS TO THE ABOVE MENTIONED POLICIES PER ATTACHED ENDORSEMENT(S). COVERAGE IS PRIMARY & NON-CONTRIBUTORY AS REQUIRED BY
<br />WRITTEN CONTRACT, PER ATTACHED ENDORSEMENT FORMS. WAIVER OF SUBROGATION APPLIES, IF REQUIRED BY WRITTEN CONTRACT.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, A 30 DAY WRITTEN NOTICE WILL BE ISSUED.
<br />RE: MASTER AGREEMENT #A-2017-172 / AGREEMENT EXTENSION# A-2017-172-011 CTWN JOB NUMBER: 3196
<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 DESCR P„ Well MefugemmtDtvision
<br />THE EXPIRATION DATE THEREOI REVIEWED&APPROVED BY:
<br />ACCORDANCE WITH THE POLICY PR
<br />® Risk Management Anayst
<br />AUTHORIZED REPRESENTATIVE01
<br />(c� 19RR-2n1A ArnRn rnavnRAT1nN All Hl hf.r rl
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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