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Digitally signed by Francine R.
<br />— Francine R. Villareal Villareal
<br />Date: ID21.07.15 4557,45 u>'no
<br />.�� JGSAOUO-01
<br />NPADILLA
<br />DATE 7/13/2021
<br />3/2021
<br />ACORO CERTIFICATE OF LIABILITY INSURANCE
<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 endorsements .
<br />PRODUCER
<br />c
<br />N ?CT Nora Padilla
<br />Corona Insurance Aggency, Inc.
<br />2275 S Main Street, Suite 101C
<br />Corona, CA 92882
<br />HICCO No, Eat: (951) 737-2270 Fa/c, No :(951 737-5927
<br />-MAIL @-
<br />D . nora ISU-CP i.tom
<br />INSURERS AFFORDING COVERAGE
<br />NAIC R
<br />INSURER A: Philadelphia Indemnity Ins Co
<br />18058
<br />INSURED
<br />INSURER B:Oak River Insurance Company
<br />34630
<br />INSURER C
<br />OCSA
<br />INSURER D
<br />1107 N. Main Street
<br />Santa Ana, CA 92701
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER' REVISION NIJMRFR:
<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 CONTRACTOROTHER DOCUMENTWITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />POLICY NUMBER
<br />fMM1LDCWEFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-Ml OCCUR
<br />X
<br />PHPK2292961
<br />711/2021
<br />7/1/2022
<br />EACH OCCURRENCE
<br />1,000,000
<br />DA AGEETO REWED
<br />100,000
<br />MED UP An one erson
<br />5,000
<br />PERSONAL S ADV INJURY
<br />1,000,000
<br />AGGREGATE LIMIT� APPLIES PER
<br />POLICY JEC- LOC
<br />GENERALAGGREGATE
<br />3,000,000
<br />GEN'L
<br />PRODUCTS-COMP/OP AGG
<br />1,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />EOMBINED SINGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJURY Per Plassont$
<br />X
<br />ANY AUTO
<br />PHPK2292961
<br />7/1/2021
<br />71112022
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY
<br />BODILY INJURY Peracoidenl
<br />AUTOS ONLY ALTNOS ONL�
<br />P �acciEanl AGE
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DELI I I RETENTIONS
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS' LIABILITY YIN
<br />AFFICEWMEMBER EXCLUDED?ECUTIVE ❑
<br />'Mandatory In NH)
<br />NIA
<br />ORWC209187
<br />7/1/2021
<br />71112022
<br />PET OTH-
<br />UT ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />1,000,000
<br />If rs, Eescdbe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE- POLICY LIMB
<br />1,000,000
<br />A
<br />Liability
<br />PHPK2292961
<br />711/2021
<br />711/2022
<br />Sexual/Abuse/Molest
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES ACORD 101, Additional Remarks Schedule, me be attached If more s ace Is require
<br />30 DAY NOTICE OF CANCELATION, EXCEPT 1 DAYS NOTICE OF CANCELLATION MR NON PAYMEGT OF PREVIUM. THE CITY OF SANTA ANA IS NAME
<br />AS ADDITIONAL INSURED: OCSA, AT ITS SOLE COST AND EXPENSE, SHALL OBTAIN AND MAINTAIN, IN FULL FORCE AND EFFECT THROUGHOUT THE
<br />,14, inL ,,.,. �. w"..c, w.u,"o�.�, ..,JN,, w inAGI.ia a..,SUBCONTRACTORS, IF ANY, BUT ALSO WITH THE EXCEPTION OF WORKERS COMPENSATION, EMPLOYERS LIABILITY AND PROFESSIONAL INSURANCE.
<br />THE CITY OF SANTA ANA, ITS COUNCIL MEMBERS, OFFICERS, AGENTS AND EMPLOYEES AS ADDITIONAL INSURED PER THE ATTACHED PI-GLD-VS.
<br />INCLUDES PRIMARY WORDING FOR ADDITIONAL INSURED. (AS RESPECTS TO WORK OF SERVICES FOR OCSA)
<br />CITY OF SANTA ANA
<br />20 CIVIC CENTER PLAZA, M29
<br />Santa Ana, CA 92702
<br />ACORD 25 (2016103)
<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 PROVISIONS.
<br />AUTHORRED REPRESENTATIVE
<br />///;T+rW/' A% 'Tt Y t0dt 1Stri AFPi;1 vEC S .
<br />CREVIEWm bapAPPRIQ'J'®BY,:
<br />W I4A�N h. VXAVAt
<br />01988-2015 ACORD C i
<br />The ACORD name and logo are registered marks of ACORD I 1 - Risk Management Analyst
<br />
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