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Francine H. vuiareai wareb
<br />ACCORV CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMlDDMY )
<br />0912812020
<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 ondorsement(s).
<br />�ROOUCER
<br />CONTACT Jennie Garcia
<br />The Empire Company
<br />PHONE (714) 836-9945 FAX (714) 836-9946
<br />o Ext AIC Nou
<br />C No.
<br />E-MAIL Igarcia@empire-Co.com
<br />ADDRESS:
<br />350 North Park Center Drive
<br />INSURERIS) AFFORDING COVERAGE
<br />_
<br />NAIL N
<br />Suite 205
<br />INSURERA: Ohio Security Insurance Company
<br />24082
<br />Santa Ana CA 92705
<br />NSURED
<br />INSURER B; Anledcan Fire and Casualty Insurance Company
<br />24066
<br />Transportation Studies Inc
<br />INSURER c: United States Liability Insurance Company
<br />25895
<br />INSURER D ;
<br />2640 Walnut Ave Ste L
<br />INSURER E:
<br />INSURERF;
<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 TOTHE 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 />VSR
<br />_TR
<br />TYPE OF INSURANCE
<br />ADDLSUER
<br />INSD
<br />WVD
<br />POLICYNIIMSF.R
<br />P UCYEFF
<br />JMmODDInnM
<br />POLCY P
<br />MMIDDIYYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />.--,I CLAIMS -MADE � OCCUR
<br />M T6_IUENTEb
<br />PREMISES(Eeoccumnce
<br />$ 500,000
<br />MED EXP (Any one person)
<br />$ 15,000
<br />PERSONAL &ACV INJURY
<br />$ 1.000,000
<br />A
<br />BK$59050934
<br />10/01/2020
<br />1010//2021
<br />GEN'LAGGREGATE LIMITAPPLIES PER.
<br />GF-NERALAGGREGATE
<br />$ 2,000,000
<br />X: POLICY ❑ PROJECT - ❑ LOC
<br />PRODUCTS-COMPIOPAGG
<br />S 2,000,000
<br />S
<br />OTHER
<br />_
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accitlenl
<br />s 1,000,000
<br />�(
<br />BODILY INJURY (Per person)
<br />ANYAUTO
<br />A
<br />OWNED SCHEbULED
<br />AUTOS ONLY AUTOS
<br />BASS9050034
<br />10101/2020
<br />10/01/2021
<br />BODILY INJURY (Par acciden)
<br />S
<br />PROPERTY DAMAGE
<br />Per accitlen0
<br />S
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />Uninsured motorist
<br />5. 1,000,000
<br />X
<br />UMBRELLA LIA4
<br />X
<br />OCCUR
<br />EACH OCCURRENCE .
<br />$ 1,000.000
<br />AGGREGATE
<br />$ 1,000,000
<br />B
<br />ExcE6s LIAR
<br />CLAIMS -MADE
<br />USA59050934
<br />10/01/2020
<br />10101/2021
<br />DEC I X RETENTION $ 10,000
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIMB R/PAR EXCLUDED?
<br />(Mandatory In NH) EXCLVDEa4
<br />(MandetarylnNHJ
<br />NIA
<br />XWS59050934
<br />10/0112020
<br />10/01/2021
<br />X STATUTE ERH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />---
<br />EL. DISEASE -EA EMPLOYEE
<br />$ 1,000,000
<br />E.I.DISEASE -POLICY LIMIT
<br />S 1,ODD,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS bat.
<br />�
<br />Each Claim
<br />$1,000,000
<br />C
<br />Errors &Omissions
<br />rrSP10P)743I
<br />10/01/2020
<br />10/01/2021
<br />Aggregate
<br />$2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (ACORD 101, Additional Renmrks Schedule, maybe attached it more space is required)
<br />Re: Agreementto Provide Trafric 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 primarylnon-wntributory
<br />wording in respect to the general liabilty coverage performs CG88100413 attached as required by written contract
<br />City of Santa Ana, Risk Management Division,
<br />4lh 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 />REVIEWED & APPROVED BY:.
<br />rusk ManagementAnalyxt
<br />© 1988.2015
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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