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Francine R. Dlglrally,ynetl by Frandne N. Villareal Dale: 2021 nat 19:5691 a7W BIGBENC-01 CTYLER .a►`oRo CERTIFICATE OF LIABILITY INSURANCE DATW6121`DIYYYY) 4/6/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER License # OM70471 CONTACT Orion Risk Management Insurance Services, An Alera Group Insurance Aggency, LLC 1800 Quail Street, Suite 110 Newport Beach, CA 92660 PHONE FAx (A/C, No, Ext: (949) 263-8850 FAX. ND):(949) 263-8860 E-MAIL Daess: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Starr Surplus Lines Ins. Co. 13604 INSURED INSURER B : INSURERC: Big Ben, Inc. 4790 Irvine Blvd. #105-404 Irvine, CA 92620 INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENTWITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLEUBR INSO WeD POLICY NUMBER POLICY EFF 4/5/2021 POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [ X] OCCUR X X 1000066896201 4/5/2022 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEDPREMISES ar a 100,000 5,000 MED EXP (My one arson PERSONAL B ADV INJURY 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER POLICY jERo- LOG GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea andilgoll ANY OWNED O OWNED SCHEDULED AUTOS ONLY AUTOSS AUT 09 ONLY AIDITN0G 0 Y BODILY INJURY Per arson S INJURY Per accident) $ BODILY Pe P.E"' YegrAMAGE $ A UMBRELLA LIAB X OCCUR EXCESS LIAB CLAIMS -MADE 1000337275201 4/5/2021 4/5/2022 EACH OCCURRENCE $ 4,000,000 X AGGREGATE 4,000,000 DIEDRETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE FICEWMEMBER EXCLUDED? El If QQF�yes. desctlbe under ory lD NH) # yes. NIA PER OTH. UTE ER E.L. EACHACCIDENT E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE- POLICY LIMB DESCRIPTION OF OPERATIONS below _[J_ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORDID1,Additional Remarks schedule, ma be attached if more space is required) City of Santa Ana, its officers, employees, agents and representatives are Additional'lnsureds With respect is named as additional insured when required by written contract per the attached General Liability endorsement. Primary and non-contributory coverage applies when required by written contract per the attached General Liability endorsement. Waiver of subrogation applies when required by written contract per the attached General Liability endorsement. 30 Days Notice of Cancellation (non -reporting if applicable) apply per policy provisions. City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92701 ACORD 25 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1tLkMmagemalEEMdmL RE�nEwEn6MPRovEO BY: C ©1988-2015 ACORD C®, The ACORD name and logo are registered marks of ACORD I I V Ruk Managernent Analyst