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Francine R. Digitally signed by FrancineR.
<br />Villareal
<br />Villareal Date:2022.01.20 13:34:07-08'00'
<br />ACCWV CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDIYYYY)
<br />01 /18/2022
<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
<br />VIG, LLC., dba/The Vestavia Group
<br />CONTACT NAME: Susan Crain
<br />PNONE . 205-552-0244 ac No): 205-244-8072
<br />E-MAIL
<br />ADDRESS: SUSan.Crafn@V2StaVlagrOUp.COm
<br />2090 Columbiana Road, Suite 2300
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Ironshore Insurance Company "A" XV
<br />25445
<br />Birmingham AL 35216
<br />INSURED
<br />INSURER B : Great American Insuance Company"A+"XIV"
<br />16691
<br />INSURER C : The Travelers Indemnity Company "A++" XV
<br />19046
<br />NaphCare, Inc.
<br />INSURER D
<br />2090 Columbiana Road, Suite 4000
<br />INSURER E
<br />Birmingham, AL 35216
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 OR OTHER DOCUMENT WITH RESPECT TO 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDD
<br />POLICY EXP
<br />MMIDD
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />N
<br />HC7BAB5A62002
<br />12/31/2021
<br />12/31/2022
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />X I CLAIMS -MADE El OCCUR
<br />DAMAGE To RENTED-
<br />PREM SES (E. occurrence)
<br />$ 50,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />Retro date: 12/31/2018
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 8,000,000
<br />POLICY PRO-
<br />JECT 7 LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 1,000,000
<br />$
<br />OTHER:
<br />_R
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />N
<br />CAP-1116396
<br />09/30/2021
<br />09/30/2022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />_
<br />$ XXXXXXXX
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$ XXXXXXXX
<br />PROPERTY DAMAGE
<br />Per accident
<br />$ XXXXXXXX
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />z
<br />OCCUR
<br />Y
<br />N
<br />HC7BAB5A67002
<br />12/31/2021
<br />12/31/2022
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LIAR
<br />CLAIMS MADE
<br />DIED RETENTION $
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBEREXCLUDED? y
<br />(Mandatory in NH)
<br />NIA
<br />N
<br />UB-1P248768-21-51-K
<br />UB-1 P250924-21-51-K
<br />09/30/2021
<br />09/30/2022
<br />X I STATUTE I ERH
<br />E.L. EACH ACCIDENT
<br />—
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />--
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Professional Liability Claims Made
<br />Y
<br />N
<br />HC7BAB5A62002
<br />12/31/2021
<br />12I31/2022
<br />2,000,000
<br />Retro: 7/01 /2003
<br />8,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />It is understood and agreed The City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as Additional Insured, as respects
<br />their contract with NaphCare, Inc.; the insurance provided by Naphcare, Inc., shall be primary and non-contributory to the insurance carried by the City of Santa
<br />Ana; The City shall receive a (30) thirty day notice of any material modification of policies, as respects their contract with NaphCare, Inc.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />Risk Management Division
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92702-1988
<br />AUTHORIZED REPRESENTATIVE
<br />o" Nye
<br />z
<br />RiskMwaganentDivision
<br />REVIEWED & APPROVED BY.
<br />01988-2015 ACORD C
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />---
<br />Risk Management Analyst
<br />
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