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Tori Pierson Digitally signed by Told Plereon
<br />-Date: 2021,08.3109:26:00-07'00'
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMMDMYY)
<br />5/201-21
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endersement(s).
<br />PRODUCER
<br />HOC Insurance Services
<br />License No. 0589960
<br />NUUNTACT AME: Halidee Callejas
<br />PHONE (415)957-0600 FAX
<br />AIC No: (415)957-ost7
<br />E-MAIL
<br />ADDRESS: hcallejas@mocins.com
<br />101 Montgomery St., Suite Boo
<br />San FranciscoCA 94104
<br />INSURED
<br />Keyser Marston. Associates, Inc.
<br />1299 4th Sreet Suite 408
<br />INSURERS AFFORDING COVERAGE
<br />NAIC p
<br />INSURER A: Massachusetts BayIns. CO.
<br />INSURER B:Allmerica Financial Benefit CO.
<br />22306
<br />41840
<br />INSURERC:Hanover Insurance Coupan
<br />22292
<br />INSURER D:
<br />INSURER E :
<br />San Rafael CA 94901
<br />Cr11/PRAGF4 nenrmsn arc LIN— .-_
<br />INSURER F:
<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 ADDL S BR
<br />LTR TYPE OF INSURANCE —onPOLICY NUMBER MMIODIYYFY MMLDDYIYEYYY LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />A
<br />CLAIMS -MADE OCCUR
<br />X
<br />ZDFM9104906
<br />12/1/2020
<br />12/1/2021
<br />EACH OCCURRENCE
<br />$ 1,000, 000
<br />DAMAGE? RENTED
<br />PREMISES Es=Mnence
<br />$ 500,000
<br />MED EXP Anyone real
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 11000,000
<br />GEN'L
<br />AGGREGATE LIMITAPPLIES PER:
<br />POl PEA LOC
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMPlOPAGG
<br />$ Included
<br />OTHER:
<br />$
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />ANYAUTD
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIREDAUTOS X NON -OWNED
<br />AUTOS
<br />Comp$500 X Coll $500
<br />X
<br />AwFA490049
<br />12/1/2020
<br />12/1/20INJURY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000, 000
<br />X
<br />NJURY (Per person)
<br />$
<br />(Per accident)
<br />$
<br />X
<br />TY DAMAGE
<br />ent
<br />$
<br />X
<br />motorkl wmbil single
<br />$ 1,000,000
<br />C
<br />X
<br />UMBRELLALIAB
<br />EXCESS LIAR
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />X
<br />UHFA49117106
<br />12/1/2020
<br />12/1/20$
<br />MOCCURRENCE
<br />CURRENCE
<br />$ 4 000 000
<br />ATE
<br />$ 9 000 000
<br />DED XRETENTION $ 0
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY V/N
<br />ANY PROPRIETORIPARTNETEXECUTIVE
<br />OFFICER(MEMBER EXCLUDED? ❑NIA
<br />(Mandatory, In NH)
<br />If yes, describe under
<br />OTH-
<br />TUTE ER
<br />E.L. EACH ACCIDENT
<br />$
<br />E.L. DISEASE - EAEMPLOYEE
<br />$
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$
<br />C
<br />Professional Liability
<br />Retention $25,000
<br />LRFD42616503
<br />Retro Date: 11/11/1976
<br />12/1/2020
<br />12/1/2021
<br />E.& WmngfolAU $1,000,000
<br />Aggregate Umll $2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be atta wd If more space Is required)
<br />City of Santa Ana, City of Santa Ana Acting as Successor Agency and/or Housing Authority of the City of
<br />Santa Ana, its officers, employees, agents, volunteers and representatives are Additional Insured with
<br />respects to the Insured's operations. This insurance is primary as respects the Entity, its officers,
<br />officials, employees, and volunteers. Any Insurance of self-insurance maintained by the Entity, its
<br />officers,officials,employees,or volunteers shall be excess of the Contractors and sha ll not contribute
<br />with it. 30 Day Notice of Cancellation/10 Day for nonpayment of premium.
<br />rFl RIPIPArc: Uni nno
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED P ro WdlMouganmLiXNdat
<br />THE EXPIRATION DATE THEREOF, NOTICE V t Rt1MWC106 APPRoyri s
<br />ACCORDANCE WITH THE POLICY PROVISIO
<br />Rhk Ater W y ement ned�al sae
<br />AUTHORIZED REPRESENTATIVE
<br />4alidee Callejas/HCA PM✓r'Jk C91lt/r+l
<br />o`V 1% ACORD COMFURAI IIIN. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />INS025 (201401)
<br />
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