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Francine R. <br />Digitally signed by <br />Francine R. Villareal <br />Villareal <br />Date:2021.08.30 <br />15:39:18-07'00' <br />MDGAS50.01 <br />CERTIFICATE OF LIABILITY INSURANCE <br />CFRAIICII <br />oATnvvvl <br />I 5/2012020/2021 <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 SYTHEPOLICIES <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(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain pclicles may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in RON of such endorsements . <br />PRODUCER <br />hatey,Jtggggins&Associates <br />455 N. El Molino Ave. <br />Pasadena, CA 91101 <br />AGT Chip Francis <br />p <br />`n"IC°,iiP,EM: <br />626396-1035 (ic.xm'(826)396.1045 <br />. Chip® <br />12LIGom <br />INSUREINS1 AFFORDINDCOVERAGE <br />lane <br />INSURER A;West American Insurance Company <br />44393 <br />INSURED <br />MDG Associates, Inc. <br />1 D722 Arrow Route, Ste, 822 <br />Rancho Cucamonga, CA 91730 <br />INSURER s:Ohlo Security Insurance Co <br />�p a�n�_-...-- <br />24082 <br />___.. <br />INSIIRERC:AmerIcan Fire & Casualty CO. <br />24086 <br />INSURER U: <br />""— <br />msuReRe: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMRFR- RFVIAMM MunnRFw• <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT; TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICHTHIS <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 />JNORim <br />TYPE OF INSURANCE <br />ADDL <br />SUOR <br />POLIO NUMBER <br />POLICY EFF <br />POLICY IXP <br />GmT3 <br />A <br />X <br />GEHL <br />X <br />CDMMERCIAL GENERALLIABRRY <br />cwMs MADE ❑X OCCUR <br />X <br />X <br />BKW57179298 <br />71V2021 <br />71112022 <br />EACH OCCURRENCE <br />1 1,000,000 <br />ENTED <br />MEDEXP Me men <br />200.000 <br />15,000 <br />PERSONAL&ADVINJURY <br />1,000,000 <br />AGG TE DMOITAPPLIES PER <br />POUCV JECT ❑LW <br />OTHER <br />GEMRA AGGREGATE <br />2,000,000 <br />PROpI1GT3-CG PIOPAGO <br />Gy 2,000,000 <br />B <br />AUTOMOBILE <br />X <br />X <br />LIABILITY <br />ANYAVTO <br />OWNED SCHEDULED <br />NAVpT06ONLV AU�IIS. LED <br />AUTOS ONLY X nl4f'o$'8"0 <br />X <br />X <br />BAS571T9298 <br />711/2021 <br />7/112022 <br />G M81 EO SINGIE UMIT <br />BODILYINmnY Per embn <br />$ 1,000,000 <br />$ <br />BODILY INJURY ParaccNar,{ <br />O. er��M1A0E <br />_t$ <br />C <br />_ <br />X <br />UMBRELLALIAB <br />Excess LIAB <br />X <br />OCCUR <br />CLAIMS+ADE <br />ESA67179298 <br />71112021 <br />71112022 <br />EACH OCCURRENCE <br />4 4,000,000 <br />AGGREGATE <br />s 410001000 <br />DEO I I RETENTIONS <br />4.000,000 <br />W THIS COMPENSATION <br />AND 6MPLOYE0.9' LIABILITY YIN <br />Mp�IYCPROPmETORIPARTNERJEXECU11VE ❑ <br />, -12M w), EXCLUDED? <br />lM W at <br />Dyyees tlesalbe OMO <br />DESCRIPTION OFOPERATION9 below <br />NIA <br />FEft OTH• <br />R <br />EL EACHACCIDENT <br />ELOISEA9E EAEAIPLO <br />—_ <br />E40L9FASE. POLIGYUMm <br />DESCRIPnON OF OPERATIONSILOCATIONS/VEHICLES (ACORD 101, A4016bnal Rbmnke 8nhedule mo heeeAbhw it more a eve le required) <br />Certificate Heldem aro named ss Additional Insured on General Liability per blani<etyform CG8810 041� and on Auto Liability perform AC8543 0618. <br />Complete Additional Insured: The City of Santa Ana, Its officers, employees, agents and volunteers, but only as respects the Insured's operations as It relates <br />to their signed contract In regards to the CDBG Adminfstraflon Consulting SONIcea per form CGO810 0413, Primary insurance and Transfer of rights or <br />recovery against others Is Included in the form. <br />'30day Notice of Cancellation except 10 days for non-payment payment or premium. <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 Department ACCORDANCE WITH THE POLICY PROVISIONS, <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana, CA 92702 AUUTTHOOFUMD REPRESENTATIVE <br />25 (2016103) l 01988-2016 ACORD CO <br />The ACORD name and logo are registered marks ofACORD itL7--,R[sk1MmWmeniDVision <br />ipAPPROVED BY. <br />„ v4va4t <br />gement Analyst <br />