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alugned TePison Tori Pierson DatOigir..=021ly0930Wzs<3bynn atop' ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM ODIYYYY) 09/02/2021 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 endorsement(s). PRODUCER CONTACT NAME: My Protection LLC 101 Gibraltar Dr Suite 3A PHONE (888) 202-3007 ac No: EMAIL ADDRESS: contact@hiscox.com INSURER B AFFORDING COVERAGE NAIC# Morris Plains NJ 07950 INSURERA: Hiscox Insurance Company Inc 10200 INSURED KFB Management Inc. 27 Gathering Hill Court INSURER B INSURER C : INSURER D : Morris Plains, NJ 07950 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADOL D SUER D POLICY NUMBER POLICY EFF MM/DO POLICY EXP MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE S(RENTED PREMISES Ea ocwnence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL S ADV INJURY $0 A Y Y UDC-4867888-CGL-21 06/11/2021 06/11/2022 LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 GEN'LAGGREGATE X POLICY PR LOG PRODUCTS - COMP/OP AGO $ S/T Gen. Agg $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E..cdder t $ BODILY INJURY (Par person) $ ANY AUTO OWNED F7 SCHEDULED AUTOS ONLY AUTOS BODILY INJURY ( Peram) itlent $ HIRED NON WNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEO I I RETENTION$ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNEWEXECUTIVE OFFICERIMEMBEREXCWDEDV ❑ NIA I PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYE $ (Mandatory In NH) If yes, d.sctlb. under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Professional Liability X UDC-4867901-EO-21 6/11/2021 06/11/2022 Aggregate 2,000,000 Per Occurrence $ 2,000,000 DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of Santa Ana, its officers, employees, agents and representatives are additional Insured with respect to the General Liability Policy Per the attached endorsement or by written contract. Insurance is primary and noncontributory and in- cludes a Waiver of Subrogation. 30 days notice of cancellation with 10 days notice of non payment of premium in accor- dance with the policy provisions. The City of Santa Ana, its officers, officials, employees, and volunteers are to be cov- ered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Contractor including materials, parts, or equipment furnished in connection with such work or operations. City of Santa Ana Risk Management Division, 20 Civic Center Plaza Santa Ana CA 92702 lafGlrl�l9 �rI11 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, 30 DAY NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD