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Last modified
11/19/2021 4:11:25 PM
Creation date
11/19/2021 4:10:29 PM
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Contracts
Company Name
BRIGHTLIFE DESIGNS, LLC
Contract #
N-2021-186-01
Agency
Public Works
Expiration Date
6/30/2022
Insurance Exp Date
10/9/2021
Destruction Year
2027
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Francine R. <br />Olgitally signed by <br />Francine R. Villareal <br />Villareal <br />Date: 2021,09.161500:29 <br />0]'00' <br />CERTIFICATE OF LIABILITY INSURANCE <br />Dn^E----n-v) <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 />B2 Insurance Services <br />CONTACT <br />NAME. <br />Nica LLOrin <br />1426 Aviation Blvd, Suite 203 <br />PH(FICNN Eat: <br />(424)206-9400 FAX N„ <br />(424)888-7660 <br />Redondo Beach, CA 90278 <br />ADDRESS: ... ..._ <br />nica@b2insurance.com <br />License#: 0122551 <br />_. <br />__ INSURER(S) AFFORDING COVERAGE. <br />NAIL# <br />INSURER A; <br />Mesa Underwriters Specialty Insurance <br />36838 <br />INSURED <br />INSURERB: <br />an <br />AmGUARD Insurance PY <br />42390 <br />Brightlife Designs LLC <br />INSURER <br />_Com <br />- - <br />16351 Gothard St, Ste C <br />INSURER D. <br />Huntington Beach, CA 92647 <br />INSURER_E: <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: <br />00006370-591763 <br />REVISION NUMBER: <br />R9 <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 CONTRACTOR OTHER DOCUMENT <br />WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 Far <br />TYPE OF INSURANCE .DL SUER POLICY NUMBER MM DPOLI OfIYVY MMI� ft ODIYYYY <br />LIMITS <br />A X_ COMMERCIAL GENERAL LIABILITY Y Y MP0004016006613 08/1012021 08/10/2022 <br />EACH OCCURRENCE s 1,000,000 <br />CLAIMS -MADE X OCCUR <br />DAMAGM-BENTED <br />PREMISES (Eeoccuromi,c) LS_ 100,000 <br />MED EKE (Any one person) $ -- 5,000 <br />PERSONAL B ADV INJURY S 1j 00,000 <br />GENL AGGREGATE LIMIT APPLIES PER <br />GENERALAGGREGATE s 2 000 DOO <br />)( POLICY _ _ PELT LOC <br />_ <br />PRODUCTS - COMPIOPAGG S 2,000,000 <br />__-S- <br />OTHER: <br />B <br />AUTOMOBILE LIABILITY Y Y BRAU048580 10/0912020 10/09/2021 <br />COMBINED SINGLE LIMIT <br />amide,d)S 1,000,000 <br />ANY AUTO <br />_LEa <br />BODILY INJURY (Per person) S <br />OWNED SCHEDULED <br />- AUTOS ONLY X I AUTOS <br />BODILY INJURY (Per accdent) S <br />HIRED X NON -OWNED <br />X': AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />(Per accident) _ S <br />Comp/Coll Deduc S $1000 <br />UMBRELLA UAB ILOCCUR <br />EACH OCCURRENCE S <br />EXCESS LIAR CLAIMS -MADE <br />AGGREGATE 5 <br />OED RETENTIONS <br />S <br />WORMERS COMPENSATION <br />PER OTH- <br />AND EMPLOYERS' LIABILITY YIN <br />STATUTE ER <br />ANY PROPRIETORIPARTNEWEXECUTIVE <br />EL EACH ACCIDENT S <br />OFFICEMMEMBER EXCLUDED? ❑ NIA <br />(Mandatory in NH) <br />E L DISEASE- EA EMPLOYEE S <br />Ifyi s. describe under- <br />DESCRIPTIONOFOPERATIONSbelow <br />E.L DISEASE -POLICY LIMIT S <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ADDED 101, Additional Remarks Schedule, maybe attached if more space is required) <br />City of Santa Ana, its officers, employees, agents and representatives are Additional Insureds <br />with respect to General Liability <br />and Auto Liability per the attached endorsements or as required by written contract. Insurance is Primary and <br />Non -Contributory <br />City of Santa Ana - Risk Management Division <br />4th Floor <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <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 PROVISIONS. <br />1QRR-in1R 4rr1An rnl <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />Printed by N <br />„ Riekfvlanegemalt Division <br />REVIEWED&APPROVEDBY: <br />8i e <br />" F r.o" z vw..bc( <br />Risk Management Analyst <br />
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