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Anryry Digitally signed by <br />y Annie Acavado <br />15:00:218/24/2021 <br />A�� o® CERTIFICATE OF LIABILITY INSURANevedo Date:20F0700' <br />E(MMDDYYYY) <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 Linda Partida <br />NAME: <br />The Liberty Company Insurance Brokers <br />HCNE. Ext : (818) 350-7479 FAAc, No <br />Lic #OD79653 <br />E-MAIL Ipartida@libertycompany.com <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />5955 De Soto Ave, Suite 250 <br />Woodland Hills CA 91367 <br />INSURERA: Sentinel Insurance Company <br />11000 <br />INSURED <br />INSURER B <br />Barboza & Associates, <br />INSURER C : <br />660 South Figueroa St Ste 1620 <br />INSURER D : <br />INSURER E : <br />Los Angeles CA 90017 <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 21-22 GLI 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 />INSD <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MWDD/YYYY <br />POLICY EXP <br />MWDD/YYYY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 2,000,000 <br />CLAIMS -MADE FX OCCUR <br />TE <br />PREM SES Ea oNcurDrence <br />$ 1,000,000 <br />MED EXP (Any one person) <br />$ 10,000 <br />PERSONAL &ADV INJURY <br />$ 2,000,000 <br />A <br />Y <br />72SBAAA9619 <br />08/07/2021 <br />08/07/2022 <br />LAGGREGATE LIMITAPPLIES PERGENERAL <br />AGGREGATE <br />$ 4,000,000 <br />POLICY ElPRO FX LOC <br />JECT: <br />MOTHER <br />PRODUCTS-COMP/OPAGG <br />$ 4,000,000 <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accide nt) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LAB <br />CLAIMS -MADE <br />DED I I RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />PER OTH- <br />AND EMPLOYERS' LIABILITY Y / N <br />STATUTE ER <br />ANY PROPRIETOR/PARTNER/EXECUTIVE ElN <br />OFFICER/MEMBER EXCLUDED? <br />/A <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />The City of Santa Ana, its officers, officials, employees, and volunteers are included as Additional Insureds on General Liability per SS 00 08 04 05, <br />(Business Liability Coverage form), subject to policy terms and conditions. General Liability is Primary and Non -Contributory per SS 00 08 04 05, (Business <br />Liability Coverage form), subject to policy terms and conditions. <br />Revises Cert Issued on 08/10/2021. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIO"'C <br />Risk Mwwg=ent Division <br />AUTHORIZED REPRESENTATIVE REVIEWED/&APPROVED BY: <br />CA 92701 64W,4, di Risk Management Specialist <br />ACORD 25 (2016/03) <br />@ 1988-2015 ACORD <br />The ACORD name and logo are registered marks of ACORD <br />reserved. <br />