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<br />llY YCORATH
<br />CERTIFICATE OF LIABILITY N n L1RXIP signed yDATE(MM/DD/YYYY)
<br />4/1 /2022
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONE S NO RIGHTS UPOI I THIS
<br />DED BY THE POLICIES
<br />BELOW. CERTIFICATE
<br />CERTIFICATE FOFw INSURANCE DOES NVELY OR IOTLCO CONSTITUTE UTEXAEND 000NTR T� �. LA(I URER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ----2-&22.04.1 Q
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIOF aL Ih1;'VrctD pro.: -inns or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, ce ma, require a@9rde�it. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsem tJ)Oies
<br />_
<br />PRODUCER CONTACT Mar -
<br />NAME:
<br />Narver Asssociates Insurance Agency PHONE FAX
<br />423 McGroarty Street (A/C, No, Ext): (626) 943-;[43 (A/C, No):
<br />San Gabriel, CA 91776 E-MAIL
<br />mtang@narver.com
<br />INSURERA:Sentinel Insurance Company,Ltd 11000
<br />INSURED INSURER B:Federal Insurance Company 20281
<br />Woodruff Spradlin & Smart, APC INSURERC:AS en Specialty Insurance Company 10717
<br />555 Anton Blvd., Suite 1200 INSURERD: Beazley Insurance Company Inc. 37540
<br />Costa Mesa, CA 92626
<br />INSURER E
<br />INSURER F :
<br />C(1VFRA(,FC CERTIFICATE KlIIMRFR• RFVICInKl KlIIMRFR-
<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 />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />72SBAUW7027
<br />4/12/2022
<br />4/12/2023
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />1,000,000
<br />$
<br />MED EXP (Any oneperson)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />X
<br />POLICY JJECT LOC
<br />PRODUCTS-COMP/OPAGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />2,000,000
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />72SBAUW7027
<br />4/12/2022
<br />4/12/2023
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />I
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />EXCESS LIAB
<br />CLAIMSMADE72SBAUW7027
<br />4/12/2022
<br />4/12/2023
<br />AGGREGATE
<br />$ 4,000,000
<br />DED X RETENTION $ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N/A
<br />X
<br />7175-0587
<br />4/1/2022
<br />4/1/2023
<br />X PER OTH-
<br />STATUTE ER
<br />1,000,000
<br />$
<br />E.L. EACH ACCIDENT
<br />E.L. DISEASE- EA EMPLOYEE
<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 />$
<br />C Professional Liab.
<br />LROOlEH21
<br />11/1/2021
<br />11/1/2022
<br />Each Claim
<br />5,0003000
<br />D ICyber Liability
<br />W30BOE210101
<br />11/1/2021
<br />11/1/2022
<br />Aggregate
<br />23000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Additional Excess General Liability limit of $1,000,000 Starstone National Ins. Co. Policy #88030P227ALI effective 4/12/2022-4/12/2023
<br />The City of Santa Ana, its officers, officials, employees, and volunteers are to be covered as additional insureds 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 />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 />ty ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />Ride & A Division
<br />REVIEWEDD & APPROVED BY.-
<br />ACORD 25 (2016/03) © 1988-2015 ACORD I
<br />The ACORD name and logo are registered marks of ACORD —r' I?i5k Management specialist
<br />
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