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Francine R. evixys.ewa.,drea
<br />Villareal a.�.
<br />OCEABLU-06 m ADAVIS2
<br />'4`�R� CERTIFICATE OF LIABILITY INSURANCE
<br />OAT/3012DIYYYV)
<br />6130/2021
<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 policy(ies) 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 # 0757776
<br />CANTACT Alisha Davis
<br />N ME:
<br />HUB International Insurance Services Inc.
<br />9855 Scranton Road
<br />Suite 100
<br />PHONE o, Ext): (677) 625-2681 FAX Nel:(951 231-2572
<br />)
<br />E-MAIESS: alisha.davis@hubinternational.com
<br />San Diego, CA 92121
<br />INSURE S AFFORDING COVERAGE
<br />NAIL ir
<br />INSURER A: Greenwich Insurance Company
<br />22322
<br />INSURED
<br />INSURER B:XL Specialty Insurance Company
<br />37885
<br />INSURER c:Indian Harbor Insurance Company
<br />36940
<br />Ocean Blue Environmental Services, Inc.
<br />INSURER D:
<br />925 West Esther Street
<br />Long Beach, CA 90813
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE MIIMRFR- RFVLCInM MI HAPPIP.
<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 CONTRACT OROTHER DOCUMENTWITH RESPECTTO WHICH THIS
<br />CERTIFICATE MAY BE 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 />HER
<br />TYPE OF INSURANCE
<br />ADDL
<br />BUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPLTR
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />GEC300156801
<br />711/2021
<br />7/112022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES(Ea occumeres)
<br />100,000
<br />MEDEXP An one ison
<br />$ 5,000
<br />PERSONAL BADV INJURY
<br />$ 1,000,000
<br />POLICY
<br />LIMIT � APPLIES PER
<br />M- LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'LAGGREGATE
<br />X
<br />PRODUCTS-COMP/OPAGG
<br />21000,000
<br />X
<br />OTHER:
<br />DIED: $5,000
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBI tlEED SINGLE LIMIT
<br />$ 1,000,000
<br />X
<br />ANYAUTO
<br />AUTOSOONLV AUUTHOSSVUyN�D
<br />X
<br />X
<br />AECO05699101
<br />71112021
<br />7/1121M
<br />BODILY IWURV War Ders..)
<br />$
<br />BODILY INJURY Per accident
<br />$
<br />Pe�ax,Cen DAMAGE
<br />$
<br />X
<br />AUTOS ONLY AUTOS ONLY
<br />MCS-90 Pollution
<br />Hazardous Waste
<br />5,000,000
<br />C
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 9,000,000
<br />AGGREGATE
<br />9+ODD,000
<br />X
<br />EXCESS LIAB
<br />CLAIMSWADE
<br />UECO05699201
<br />71112021
<br />71112022
<br />DED I X I RETENTION$ 10,000
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE YIN
<br />pp�-Mat ry inN qIEXCLUDED?
<br />(Mantlatory,n NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />X
<br />WEC300156701
<br />71112021
<br />71112022
<br />�( PER OTH-
<br />STATUTE ER
<br />E.L EACH ACCIDENT
<br />$ 1,000,000
<br />E.L DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 7,D00,000
<br />C
<br />Pollution I Environm
<br />X
<br />PECO05703301
<br />711/2021
<br />71112022
<br />Each Occ/Aggregate
<br />5,000,000
<br />C
<br />Professional Liab
<br />PECO05703301
<br />7/112021
<br />7/112022
<br />Each Occ/Aggregate
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />RE: A-2021.097.01 and RFP #21-004
<br />City of Santa Ana, officers, agents, employees, and volunteers are Additional Insured's with regards to the General Liability policy when required by a written
<br />contract, per the attached endorsement forms CG2010 12119 and CG2037 12119. Primary wording applies with regards to the General Liability policy when
<br />required by a written contract, per the attached endorsement form XIL424 06105. Waiver of Subrogation applies with regards to the General Liability policy
<br />when required by a written contract, per the attached endorsement form CG240412119. Additional Insured applies with regards to the Auto Liability policy
<br />when required by a written contract, per the attached endorsement form XIC411 10113. Waiver of Subrogation applies with regards to the Auto Liability policy
<br />when required by a written contract, per the attached endorsement form CA044410113. Auto Pollution applies per the attached form CA9948 10113. Waiver of
<br />SEE ATTACHED ACORD 101
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE
<br />_ n IA '�FS' `,"�. ?` o_•M1¢tT2 Management I
<br />ont
<br />iEVIEVVED & APPROPVE®BY.
<br />ACORD 25 (2016/03) @ 1988-2015 ACORD C
<br />The ACORD name and logo are registered marks of ACORD - Risk Management Analyst
<br />
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