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Tori Pierson Digitally signed by Tod Pierson
<br />Date: 2021.08.310BM:00-07WY
<br />A� 0® CERTIFICATE OF LIABILITY INSURANCE
<br />DAS/zD/2onz )
<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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME: Halidee Callejas
<br />MOC Insurance Services
<br />PHONE (415) 957-0600 FAX,
<br />Na. (415)957-on7
<br />License No. 0589960
<br />EMAIL ADDRESS: hcallejas@matins. tom
<br />101 Montgomery St., Suite 800
<br />INSURERS AFFORDING COVERAGE
<br />NAIC R
<br />INSURERA: Massachusetts Bay Ins. Co.
<br />22306
<br />San Francisco CA 94104
<br />INSURED
<br />INSURER B: Allmerica Financial Benefit Co.
<br />41840
<br />INSURERC:Hanover Insurance Company
<br />22292
<br />Keyser Marston Associates, Inc.
<br />INSURER D:
<br />1299 4th Sreet Suite 408
<br />INSURER E
<br />INSURER F:
<br />San Rafael CA 94901
<br />COVERAGES CERTIFICATE NUMBER: GL-AUTO-UI.M-E&O REVISION NUMBER:
<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 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />BUHR
<br />POLICY NUMBER
<br />POLICY EFF
<br />(MMIDDNYYYI
<br />POLICY EXP
<br />MMIDDIYYYYJ
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MAOE M OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />ITANAGA
<br />PREMISES
<br />ES(Ed TO ocu
<br />PREMISES Ea occurtence
<br />$ 500,000
<br />MED EXP(Any one person)
<br />$ 10,000
<br />X
<br />ZDFA49104906
<br />32/1/2020
<br />12/1/2021
<br />PERSONAL &AOV INJURY
<br />$ 1,000,000
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />POLICY [�fl JPECT FLOC
<br />GENERALAGGREGATE
<br />$ 21000,000
<br />PRODUCTS-COMP/OPAGG
<br />$ Included
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident)
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />B
<br />ANYAUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AO
<br />X
<br />AwFA490049
<br />12/1/2020
<br />12/1/2021
<br />BODILY INJURY Per accident
<br />( )
<br />$
<br />NON-0Wsi
<br />AUTOS
<br />HIRED AUTOB NX
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X
<br />Uninsured material combined sins
<br />$ 1,000,000
<br />Coup$5, Coll$500
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4 000 000
<br />AGGREGATE
<br />$ 4,000,000
<br />D
<br />EXCESS LIAR
<br />CLAIMS-AMDE
<br />DIED I X I RETENTION $ 0
<br />$
<br />X
<br />MFA49117106
<br />12/1/2020
<br />12/1/2021
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$
<br />ANY PROPRIETOR/PARTNEWEXECUTIVE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />NIA
<br />E.L. DISEASE -EA EMPLOYEE
<br />$
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />EL.DISEASE -POLICY LIMIT
<br />$
<br />C
<br />Professional Liability
<br />LHM42616503
<br />12/1/2020
<br />12/1/2021
<br />Each Wrongful Ad $1,000,000
<br />Retention $25,000
<br />Retro Date: 11/11/1976
<br />Aggregate Limit $2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101. Additional Remarks Schedule, maybe aftachad if more space is required)
<br />City of Santa Ana, City of Santa Ana Acting as Successor Agency and/or Housing Authority of the City of
<br />Santa Ana, its officers, employees, agents, volunteers and representatives are Additional Insured with
<br />respects to the Insured's operations. This insurance is primary as respects the Entity, its officers,
<br />officials, employees, and volunteers. Any Insurance of self-insurance maintained by the Entity, its
<br />officers,officials,employees,or volunteers shall be excess of the Contractor's and shanll not contribute
<br />with it. 30 Day Notice of Cancellation/10 Day for nonpayment of premium.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />ACORD 25 (2014101)
<br />INS025 (201401)
<br />SHOULD ANY OF THE ABOVE DESCRIBED P
<br />THE EXPIRATION DATE THEREOF, NOTICE
<br />RIA MnirgenntDublen
<br />/��la '.;, IRVEMED r &APPmoi B
<br />ACCORDANCE WITH THE POLICY PROVISIO
<br />' 7671;joccift
<br />rusk WuP,eme tChiral Aide
<br />AUTHOMMO REPRESENTATIVE
<br />Halidee Callejas/HCA
<br />11''
<br />H4iida �.1/qd
<br />© 1988-2014 ACI
<br />The ACORD name and logo are registered marks of ACORD
<br />
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