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ACORO CERTIFICATE OF LIABILITY INSURANCE
<br />L/
<br />DATE(MMIDDIYYYY)
<br />1 08/27/2021
<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 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 poltcy(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 endorsements .
<br />PRODUCER
<br />Dickerson Insurance Services an Alera Group Company
<br />1918 Riverside Drive, Los Angeles, CA 90039
<br />License#OM29112
<br />CONTACT Nora Wolkoff
<br />NAME:
<br />PHONE 323-805-2918 PUC Net
<br />nuD Nora@dickerson-group.cem
<br />INSURERS AFFORDING COVERAGE
<br />NAICM
<br />INSURER A: Philadelphia Indemnity Insurance Company
<br />21044
<br />INSURED
<br />INSURER B: Technology Insurance Company
<br />42376
<br />Charitable Ventures of Orange County
<br />INSURER c: Hiscox Insurance Agency
<br />10200
<br />1505 E. 17th Street, Suite 101
<br />INSURER D:
<br />Santa Ana, CA 92705
<br />INSURER E:
<br />INSURER F:
<br />CUVEHAGES CERTIFICATE NUMBER: RFVICInN NIIMRF:a
<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 />ILTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />Men
<br />SUBR
<br />wVnPOLICY
<br />NUMBER
<br />POUCYEFF
<br />NIN
<br />POLICY UP
<br />MMIDD
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ® OCCUR
<br />Abuse & Molestation (A&M)
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />TO
<br />PREMIS
<br />P REMISEES S( RENTEDEe accunence
<br />$ 100,000
<br />MED UP (Any one person)
<br />$ 5,000
<br />Professional Liability(Prof. Liab)
<br />PERSONALAAOVINJURY
<br />$ 1,000,000
<br />A
<br />X1
<br />Y
<br />Y
<br />PHPK2302279
<br />07/15/2021
<br />07/01/2022
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY JEST LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GENT
<br />PRODUCTS-COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Par person)
<br />$
<br />ANY AUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />Y
<br />Y
<br />PHPK2302279
<br />07115/2021
<br />07/01/2022
<br />BODILY INJURY accident Per
<br />( )
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />U MBRELLA MB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />$ 4,000,000
<br />A
<br />I EXCESS Me
<br />CLAIMS -MADE
<br />Y
<br />Y
<br />PHUB777844
<br />07/15/2021
<br />07/01/2022
<br />DED X1 RETENTIONa 10,000
<br />A&M and Prof. Liab.
<br />$ Included
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'MBILRY YIN
<br />ANY PROPRIETORIPARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? F-Y]
<br />NIA
<br />Y
<br />TWC4004913
<br />07/15/2021
<br />07/01/2022
<br />PER OTH-
<br />STATUTE ER
<br />EL EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS betel
<br />E.L DISEASE -POLICY LIMB
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD let, Additional Remarks schedule, may be attached if more apace is required)
<br />RE: Santa Ana Active Streets project
<br />City of Santa Ana, its officers, employees, volunteers, agents and representatives are named as Additional Insureds, on a primary and non-contributory basis,
<br />as respects to the above mentioned General Liability and Automobile Liability coverages as required by written contract, subject to policy terms and conditions.
<br />Notice of Cancellation - Each insurance policy required above shall provide that coverage shall not be Canceled, except with notice to the Entity. City will be
<br />mailed 30 days written notice.
<br />Workers' Compensation is evidence of insurance only.
<br />City of Santa Ana
<br />Risk Management Division
<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 />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD V
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