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<br />GGUMMLEG-01
<br />VPAINTE
<br />DAT/2712Ur/YYY)
<br />8/27/2021
<br />lh. R CERTIFICATE OF LIABILITY INSURANCE
<br />�►-r''
<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 poiicy(les) 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 endorsement(s).
<br />PRODUCER License ff OC32169
<br />NTACT
<br />Rancho Mesa Insurance Services, Inc.
<br />250 Riverview Parkway
<br />Santee, CA 92071
<br />PHONE FAX
<br />(AIC, No, E.t): (619) 937-0164 AIC, No):(619) 937-0168
<br />E-MAIL
<br />INSURERS AFFORDING COVERAGE
<br />NAIC If
<br />INSURERA:Arch Insurance Company
<br />11150
<br />INSURED
<br />INSURER B: Service American Indemnity Company
<br />39152
<br />INSURER C :
<br />Community Legal Aid SoCal
<br />INSURER D :
<br />2101 North Tustin Avenue
<br />Santa Ana, CA 92705
<br />INSURER E
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 1 REVISION NUMRFR-
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OROTHER DOCUMENT WITH RESPECTTO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTOALL THETERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />Man
<br />SUER
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />p
<br />POLICY EXP
<br />(MMiDDIVYYY1
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />AAPKGO046503
<br />91112021
<br />9/1/2022
<br />EACH OCCURRENCE
<br />1,000,000
<br />DAMAGE TOR NTEDn
<br />1,000,000
<br />GEN'L
<br />MED EXP (Any oneperson)
<br />25,000
<br />PERSONAL &ADV INJURY
<br />1,000,000
<br />AGGREGATE LIMIT APPLI ES PER:
<br />POLICYT [X]LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />2,000,000
<br />PRODUCTS-COMP/OPAGG
<br />2,000,000
<br />A
<br />POMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />AUTOS ONLY X 0008W ELY D
<br />AAPKGO046503
<br />911/2021
<br />91112022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />BODILY INJURY Per erson)_
<br />BODILY INJURY Per accident
<br />$
<br />PeOF tlenl AMAGE
<br />A
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />AAFX60046503
<br />9/1/2021
<br />911/2022
<br />EACH OCCURRENCE
<br />3,000,000
<br />AGGREGATE
<br />31000,000
<br />DIED I X RETENTION$ 0
<br />B
<br />WORKERS COMPENSATION
<br />ANDD EMPLOYERS' LIABILITY YIN
<br />We PRRROPRIETORIPARTNERIEXECUTIVE
<br />(Mantlatory In NH) EXCLUDED?
<br />If yee, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />SATIS0340101
<br />91112021
<br />9/1/2022
<br />X STATUTE 10RTH-
<br />El. EACH ACCIDENT
<br />1,000,000
<br />E.L. DISEASE LA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />A
<br />Abuse & Molestation
<br />AAPKGO046503
<br />91112021
<br />911/2022
<br />Occ.$1 M/Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, ma be attached if more space Is required)
<br />MED RE: OPERATIONS OF THE NAINSURED AS CERTIFICATE HOLDERS INTERESVMAY APPEAR.
<br />City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or
<br />memorandum of understanding. Such insurance as Is afforded by this policy shall be primary, and any insurance carried by City shall be excess and
<br />noncontributory.
<br />CITY OF SANTA ANA
<br />RISK MANAGEMENT DIVISION
<br />20 CIVIC CENTER PLAZA
<br />SANTA ANA, CA 92701
<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 PROV!"'-""
<br />ITHORIZE VREPRESENTATIVE REVIEWED&APPROVED 6Y:
<br />aG �r euav `io
<br />`� ftNeManaDer,mtCleriuriAide.
<br />ACORD 25 (2016/03) ©1988.2015 ACORD C( V'
<br />The ACORD name and logo are registered marks of ACORD
<br />
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