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Tori Pierson Baia:202 Tod Human <br />M291 <br />DATE(MM/DD/YYYY) <br />09/27/2021 <br />A✓ d CERTIFICATE OF LIABILITY INSURANCE 1 <br />PRODUCER <br />Maguire Insurance Agry, enInc FWI <br />PA1 1 Bala Plc She <br />Bala Cynwyd. PA 90D4-14D3 <br />610.617.7900 <br />THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />I NAICA <br />INSURED <br />INSURER A: Philadelphia Indemnity lnsunnce Company <br />18058 <br />Mancini Sewndo <br />7143 Fulton Way <br />Stanton, CA 90660- <br />INSURER B: <br />INSURER C <br />....... ._ _. <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERIFICATION MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />ADD-L <br />POUCY EFFECTIVE <br />POUCYEXPIRAMON <br />LTR <br />INSRD <br />TYPE OF INSURANCE <br />POUCYNUMBER <br />DATE(MM/DD/YYYY) <br />DATE(MM/OD/YYYY) <br />LIMAS <br />A <br />X <br />GENEWLIABILITY <br />PHPK2330395-000 <br />09/27/2021 <br />09/22/= <br />EACHOCCURENCE <br />$1,aW,000 <br />PREMISES Eac mence <br />$100,000 <br />X COMMERCIAL GENERAL UABILITY <br />CIAIMSMADE ❑% OCCUR <br />MEDEXPlgnyoneperaon) <br />$2,500 <br />PERSONAL&AOV INJURY <br />$11000,000 <br />X PR OFESSIONALLIABIUTY <br />GENERAL AGGREGATE <br />$3,000,000 <br />PRODUCTS—COMP/OPAGG <br />$3,rill 0 <br />GENT AGGREGATE UNIT APPLIES PER: <br />X POUCY 7 PROJECT LOC <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />ANYAUTO <br />(Mamident) <br />ALLOWNEDAUTOS <br />BODILY INJURY <br />SCHEDULED AUTOS <br />(Perperson) <br />HIREDAUTOS <br />BODILYINJURY <br />NON-OWNEDAUTDS <br />(Per.F.Ident) <br />PROPERTY DAMAGE <br />(Peraccident) <br />GARAGE UABRITY <br />AUTOONLY—EAACODENT <br />ANY AU O <br />THAN EAACC <br />AM <br />AURI ONLY: AGG <br />EXCESS / UMBRELLA UABIUTY <br />EACH OCCURENCE <br />AGGREGATE <br />OCCUR ❑ CTAIMS MADE <br />DEDUMBLE <br />RETENTION <br />EMPLOYERS'LIABILTTY Y/N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE O <br />OFFICER/MEMBER EXCLUDED! <br />WC STATU- <br />TORYUMITS ER <br />E.1- EACH ACCIDENT <br />E.L DISEASE —FA AMPLOYEE <br />(Mandatory in NH) <br />Ifyes LpFzfle under <br />below <br />E.L.DISEASE— POLICY LIMIT <br />OTHERLPROVISIONS <br />OTHER <br />DESCRIPTION OF OPERATIONS /LOCATIONS/ VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />It Is undmoduod and agreed that the following entity is added as an additions insured but md, with respa.als) in the operations of the named Insured except that liability resulting from the additional insured'. sole <br />negligence. <br />CERTIFICAT E HOLDER CANCELLATION <br />City of Samm Ana Risk Management Dihnson <br />20 Civic Center Plaza <br />Santa Ana, CA 92702- <br />THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NONCE TO THE <br />CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR <br />UABILrfY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. <br />b Rbk MLrRgeMnt LXuNm <br />�`. ° RentarEn6 APpgw®Br ;y <br />ACORD 25 (2009/01) 0 1988-2009 ACORD CORPORATION <br />The ACORD name and logo are registered marks of ACORD RiaRraL,DayepX.,tammlad <br />