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Digitally signed by Ton Pierson
<br />on Pierson Date: 2021.10.13 10:07:23 -07'00'
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<br />A� " CERTIFICATE OF LIABILITY INSURANCE
<br />FDATE (MM/DD/YYYY)
<br />10/8/2021
<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 />Risk Strategies Company
<br />CONTACT
<br />NAME: Emil Elsbree
<br />700 Airport Boulevard, Suite 300
<br />Burlingame, CA 94010
<br />HONE. Ext : 650 762-0425 FAX,No : 650 762-0490
<br />E-MAIL
<br />ADDRESS: eelsbree@risk-strategies.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Sentinel Ins. Co.
<br />11000
<br />INSURED
<br />Circlepoint
<br />200 Webster Street, Suite 200
<br />INSURER B : Hartford Accident and Indemnity Company
<br />22357
<br />INSURERC: AXIS Insurance Company
<br />37273
<br />INSURERD: Berkley Assurance Company
<br />39462
<br />Oakland CA 94607
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 64482228 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 />A
<br />/
<br />COMMERCIAL GENERAL LIABILITY
<br />/
<br />/
<br />57SBARI3554
<br />10/1/2021
<br />10/1/2022
<br />EACH OCCURRENCE
<br />$2,000,000
<br />CLAIMS -MADE Iv]OCCUR
<br />DA AGE To RENTED
<br />'REMIS ES (E. occurrence)
<br />$ 1 ,000,000
<br />V
<br />MED EXP (Any one person)
<br />$ 10,000
<br />Contractual Liability
<br />PERSONAL & ADV INJURY
<br />$2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$4,000,000
<br />PRO -
<br />POLICY ✓� ECT LOC
<br />PRODUCTS - COMP/OPAGG
<br />$4,000,000
<br />1�
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />57SBARI3554
<br />10/1/2021
<br />10/1/2022
<br />LIMIT
<br />(Eaaccident)
<br />$2 OOO,OOO
<br />$2,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />✓
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY ✓ AUTOS ONLY
<br />A
<br />�/
<br />UMBRELLA LAB
<br />�/
<br />OCCUR
<br />57SBARI3554
<br />10/1/2021
<br />10/1/2022
<br />EACH OCCURRENCE
<br />$3,000,000
<br />AGGREGATE
<br />$ 3,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED ✓ RETENTION $10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />57WECGH2835
<br />10/1/2021
<br />10/1/2022
<br />�/ STATUTE EERH
<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 />C
<br />Professional Liability
<br />DP004180032021
<br />10/1/2021
<br />10/1/2022
<br />Per Claim $2,000,000
<br />Retroactive Date 1: 11/01/1987
<br />Annual Aggregate $2,000,000
<br />Retroactive Date 2: 05/14/2015
<br />Pollution Liability Included
<br />D
<br />C ber Liability
<br />BCRS1 RS40009500
<br />7/16/2021
<br />7/16/2022
<br />Per Claim $2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Agreement No. A-2020-241-06
<br />The City of Santa Ana, it's officers, employees, agents, and representative are included as additional per form SS00080405
<br />where primary insurance and waiver of subrogation also apply with respects to General Liability. 30 day notice of cancellation applies with respects
<br />to General Liability and Auto Liability per form SS 12230611. 30 day notice of cancellation applies with respects to Workers Compensation per policy
<br />form WC990394. Circlepoint Project Number 4797.0
<br />CERTIFICATE HOLDER CANCELLATION
<br />© 1988-2015 ACORD C( v Risk Manegemenr Cl erical,%de
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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