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t-rancine H. vulareal vawre, <br />J!EoR CERTIFICATE OF LIABILITY INSURANCE <br />DATE Y) <br />09/2812I28/2D/YY1 <br />020 <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 statementon <br />this certificate does not confer rights to the Certificate holder in lieu of such endorsement(a). <br />'RODUCER <br />CONTACT Jennie Garcia <br />NAME: <br />the Empire Company <br />PmcNxa E igj(714) 836-9945 ac Net: (714) 836-9946 <br />350 North Park Center Drive <br />ENat jgarcia@empireco.com <br />ADDRESS: <br />INSURE S AFFORDING COVERAGE <br />NAIC a <br />Suite 205 <br />INSURERA: Ohio Security Insurance Company <br />24082 <br />Santa Ana CA 92705 <br />NSURED <br />INSURER B: American Fire and Casualty Insurance Company <br />24066 <br />INSURER C: United States Liability Insurance Company <br />25895 <br />Transportation Studies Inc <br />2640 Walnut Ave Ste L <br />INSURER D : <br />INSURER E : <br />_ <br />INSURER F: <br />Tustin CA 92780 <br />OVERAGES CERTIFICATE NUMBER: 20-21 Master 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 MATH 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 />VTR <br />SR <br />TYPE OF INSURANCE <br />POUCYNUMBER <br />MNWW CY EFF <br />MD C <br />UNITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />S 1,000.000 <br />CLAIMS -MADE ® OCCUR <br />DAMAGED <br />PREMISE'rEs�ne unce <br />$ 500,000 <br />MED EXP A are person <br />6 15,000 <br />PERSONAL& ADV INJURY <br />$ 1,000,000 <br />A <br />BKS59050934 <br />10/01/2020 <br />1010112021 <br />GEN'LAGGREGATE LIMITAPPLIES PER. <br />GENERALAGGREGATE <br />5 2,000,000 <br />X POLICY ❑ JET D LOC <br />PRODUCTS-COMP/OPAGG <br />$ 2.000,000 <br />- <br />S <br />OTHER <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE UNIT <br />Ea accident <br />S 1,000,000 <br />BODILY INJURY (Per person) <br />5 <br />ANY AUTO <br />A <br />OWNED SCHEOULED <br />AUTOS ONLY AUTOS <br />BAS59050934 <br />10/01/2020 <br />10/01/2021 <br />BODILY INJURY (Par ecerden0 <br />S <br />PROPERTYDAMAGE <br />Per arxddenl <br />S <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />Uninsured motorist <br />$ 1.000.000 <br />Ij <br />X <br />UMBRELLA UAB <br />OCCUR <br />..........�,.....,,,y.,. "..... <br />EACH OCCURRENCE <br />$ 1,000.000 <br />AGGREGATE <br />$ 1,000,000 <br />B <br />EXCESS LIA6 <br />CLAIMS -MADE <br />USA59050934 <br />10/01/2020 <br />10/0112021 <br />DED I X RETENTION $ 10'000 <br />5 <br />A <br />WORKERS COMPENSATION <br />ANDEMPLOYERTUA6ILITY YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICFR/MEMSER EXCLUDED? FTI(Mandatary in NH) <br />NIA <br />XWS59050934 <br />10f01/2020 <br />1W0112021 <br />PER OTH- <br />STATUTE FOR <br />E.L. EACHACCIDENT <br />S 1,000,000 <br />EL. DISEASE -EA EMPLOYEE <br />S 11000-000 <br />E.1- DISEASE -POLICY LIMIT <br />$ 1.000,000 <br />It yes, describe under <br />DESCRIPTION OF OPERATIONS belarr <br />Each Claim <br />$1,000,000 <br />C <br />Errors & Omissions <br />SP10227431 <br />10/01)2020 <br />10/0112021 <br />Aggregate <br />$2,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORO 101. Additional Remarks Schedule, may be attached It more space Is required) <br />Re: Agreement to Provide Traffic Counting Services on an On -Call Basis <br />The City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as additional insureds with primary/non-contributory <br />wording in respect to the general liability Coverage per fors CG881 OD413 attached as required by written contract <br />City of Santa Ana, Risk Management Division, <br />4m Floor <br />20 Civic Center Plaza <br />Santa Ana <br />CA 92702 <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 />AUTHORIZED REPRESENTATIVE <br />©1988-2015 <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />s'' AmsArwgmlmr umaum <br />REvILIVED&APPROVEDBY: <br />® Rlik Management Analyst <br />