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Francine R. oyaap,m��sr n.�n�.a <br />Client#:25320 KIMLHORN Villareal <br />ACORDT. CERTIFICATE OF LIABILITY INSURANCE <br />Daronvrr) <br />3/27/207/2021 <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 any rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Grayling Ins. Brokerage/EPIC <br />3780 Mansell Road, Suite 370 <br />Alpharetta, GA 30022 <br />CONTACT NAME: ry Jer N oyola <br />ac° Na EXt:770.220-7699 A/C No: <br />E-MAIL <br />ADDRESS: jerry.noyola@greyling.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIL # <br />INSURER A: National Union Fire Ins. Co. <br />19445 <br />INSURED <br />421 Fayetteville Street, Suite 600 y-Horn and Associates, Inc. <br />21 F <br />Raleigh, NC 27601 <br />INSURERS: Allied World Assurance Company (U.S.) <br />19489 <br />INSURER C: Everest National Ins Co <br />10120 <br />INSURERD: New Hampshire Ins. Co. <br />23841 <br />INSURER E: Lloyds of London <br />085202 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 21-22 REVISION N HVIRFR• <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 CONTRACTOR 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 />LTRR <br />TYPE OFINSURANCE <br />ADDLSUB <br />IN <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYYY) <br />POLICY EXP <br />(MWDDNYM <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LABILITY <br />CLAIMS -MADE 51 OCCUR <br />Contractual Liab <br />GL5268169 <br />04101/2021 <br />04101/2022 <br />EACH OCCURRENCE <br />$1000000 <br />PREMISESOEaECNccru ante <br />$500,000 <br />X <br />MED UP (Any one person) <br />$25,000 <br />PERSONAL &ADV INJURY <br />$1,000,000 <br />GEN'LAGGREGATE <br />LIMIT APPLIES PER: <br />POLICY � JECOT a LOC <br />GENERALAGGREGATE <br />$2,000,000 <br />PRODUCTS-COMPIOPAGG <br />$2,000,000 <br />IS <br />OTHER: <br />A <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />CA4489663 <br />4/01/2021 <br />04/01/202 <br />GLE LIMIT <br />COMBIEa accident) <br />$2,000,000 <br />BODILY INJURY (Per person) <br />$ <br />X <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />AUTOS ONLY X AUTOS ONNON LY <br />BOOILV INJURY ) <br />(Per accitlent <br />$ <br />PROPERTY DAMAGE <br />Per accitlent <br />$ <br />$ <br />B <br />X <br />UMBRELLgLIA6 <br />X <br />OCCUR <br />03127930 <br />04/01/2021 <br />04/01/202 <br />EACH OCCURRENCE <br />$5 000 000 <br />AGGREGATE <br />$5 000 000 <br />C <br />X <br />EXCESSLIAB <br />CLAIMS -MADE <br />XCBEX00363211 <br />04/01/2021 <br />04/0112022 <br />DED I X RETENTION$10000 <br />$ <br />D <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILITY <br />ANY PROPRIEfORIPARTNER/EXECUTIVEYIN <br />OFFICERIMEMBER EXCLUDED? <br />NIA <br />WC015893685 AOS <br />( ) <br />WC015893686(CA) <br />04/01/2021 <br />04/0112021 <br />04/01/202 <br />04/01/202 <br />X EiIiNIUIE PER FIR <br />E.L. EACH ACCIDENT <br />$100- OOO <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 />EL.DISEASE-POLICY LIMIT <br />$1,000,000 <br />E <br />Professional Liab <br />B0146LOUSA2104949 <br />4/01/2021 <br />04/01/202 <br />Per Claim $2,000,000 <br />Aggregate $2,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached it more space is required) <br />Re: City of Santa Ana On -Call Environmental Projects. The City of Santa Ana, its officers, employees, <br />agents, volunteers & representatives are named as Additional Insureds with respects to General Liability <br />where required by written contract. The above referenced liability policies with the exception of workers <br />compensation & professional liability are primary & non-contributory where required by written contract. <br />Should any of the above described policies be cancelled by the issuing insurer before the expiration date <br />(See Attached Descriptions) <br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />4th Floor AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92701-0000 /�i4 A �ManagDneRtDi»IAn <br />.�.J� w REVIEWED&APPROVEDBY: <br />©1988-2015 ACORD FaF'1.cL1`e �• �� <br />ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD Risk Management Analyst <br />#S2654710/M2652705 <br />