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Tori Pierson o:;eo2`on,^,"az;:roe.
<br />WOODSPR-01 YCORATHERS
<br />'4`� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 101281202YY)
<br />10/2812021
<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 endorsemen s).
<br />PRODUCER
<br />CONTACT Samantha Chung Ogura
<br />Narver Asssociates Insurance Agency
<br />423 McGroartv Street
<br />San Gabriel, CA 91776
<br />PHONE FAX
<br />I JCC Ne, Ext: (626) 943-2208 (A/C, No
<br />EDoREss: sogura@narver.com
<br />INSURER B AFFORDING COVERAGE
<br />NAIC e
<br />INSURER A: Sentinel Insurance Company, Ltd
<br />11000
<br />INSURED
<br />INSURER B:Federal Insurance Company
<br />20281
<br />INSURER C:Aspen Specialty Insurance Company
<br />10717
<br />Woodruff, Spradlin & Smart, APC
<br />INSURER 0 : Underwriters at Lloyd's, London
<br />15792
<br />555 Anton Blvd., Suite 1200
<br />Costa Mesa, CA 92626
<br />INSURER E :
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER- REVISION MI ManoD•
<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 />TYPE OF INSURANCE
<br />ADDLSUBR INSO
<br />MePOLICY
<br />NUMBER
<br />POLICY EFF
<br />POLICY EXPLTR
<br />LIMITS
<br />A
<br />X
<br />COMMERCIALGENERALLIABILITY
<br />CLAIMS -MADE ❑X OCCUR
<br />X
<br />X
<br />72SBAUW7027
<br />4112/2021
<br />411212022
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />PAMAGET RENTED
<br />REMISES Me
<br />$ 1,000,000
<br />NED EXP (Any ono arson
<br />$ 10,000
<br />PERSONAL B ADV INJURY
<br />$ 2,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY SET D LOC
<br />GENERAL AGGREGATE
<br />4,000,000
<br />GEN'L
<br />X
<br />PRODUCTS-COMP/OPAGG
<br />4,000,000
<br />OTHER
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED cod OfSINGLE LIMIT
<br />$ 2,000,000
<br />BODILY INJURY Perperson)
<br />$
<br />IxANY
<br />AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />72SBAUW7027
<br />411212021
<br />411212022
<br />BODILY INJURY Per accident
<br />$
<br />HIftE� X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />ROPERTV AMAGE
<br />Per ac RQ
<br />$
<br />A
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIM&MADE
<br />72SBAUW7027
<br />411212021
<br />4112/2022
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />5,000,000
<br />X
<br />DED RETENTION$ 10,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE Y�
<br />QFFICEWMEMBER EXCLUDED?
<br />,Mandatory in NH)
<br />(, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />X
<br />TITS-0587
<br />411/2021
<br />4N12022
<br />X PER OTH-
<br />TAT E
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE -EA EMPLOYE
<br />1,000.000
<br />$
<br />E.L. DISEASE- POLICY LIMIT
<br />1,000,000
<br />C
<br />Professional Liah.
<br />LR001EH21
<br />11/1/2021
<br />11/112022
<br />Ea.Claim
<br />5,000,000
<br />D
<br />Cyber Liability
<br />EHJ-AD1008866511
<br />11/1/2020
<br />11/212020
<br />Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mores ace is reeqquired)
<br />The City of Santa Ana, its officers, officials, employees, and volunteers are to be covered as additionaPinsure oa as respects attached General Liability
<br />endorsements SS 4170 and SS 4172 as required by contract. Such insurance is primary and non-contributory as per attached General Liability form SS 00 08.
<br />Waiver of subrogation applies as per attached General Liability form SS 00 08 and Workers Compensation form WC 90 03 75.
<br />30 day notice of cancellation.
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />PO Box 1988
<br />Santa Ana, CA 92702-1988
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROM""-"'
<br />AUTHORIZED REPRESENTATIVE � + MMlage,lod OfiWo.
<br />RenevlwEo6 AfvRor�9r.
<br />/f 4i
<br />Rex m,,,ayn,en o e� �I A:x
<br />ACUKU 25 (20161(13) ©1988-2015 ACORD CC I' IN
<br />The ACORD name and logo are registered marks of ACORD
<br />
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