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Tod Piersonoae:2021.1 by Ton
<br />DAVIROS-01
<br />MNAVARR
<br />OATDII'YYY)
<br />1017/2/7/2021
<br />AcoR�" CERTIFICATE OF LIABILITY INSURANCE
<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 endorsements .
<br />PRODUCER
<br />CONTACT
<br />Chambers & Company Insurance Brokers
<br />751 E Daily Dr. Suite 230
<br />Camarillo, CA 93010.0761
<br />PHONE FAX
<br />(A/C, No, Ext): (800) 272-3256 (A/C, No):(805) 388-7138
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Sentinel Ins Company Ltd.
<br />11000
<br />INSURED
<br />INSURERS: PrOP & Cas Ins Co of Hartford
<br />34690
<br />David Paul Rosen
<br />DBA: David Paul Rosen & Associates
<br />INSURER C: Lloyds of London
<br />15792
<br />3527 Mt. Diablo Blvd. #361
<br />INSURER D :
<br />INSURER E:
<br />Lafayette, CA 94549
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: RFVISION NIIMRFR-
<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 CONTRACTOROTHER DOCUMENTWITH 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 />LTRA
<br />TYPE OFINSURANCE
<br />AOOL
<br />SUER
<br />POLICYNUMBER
<br />POLICYEFF
<br />411/2021
<br />POLICY EXP
<br />411/2022
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAJMS-MADE X OCCUR
<br />X
<br />72SBAAK7546
<br />FACHOCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />SES Ea o c nenre
<br />1,000,000
<br />MED EXP (Any oneperson)
<br />10,000
<br />PERSONAL &ACV INJURY
<br />1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />POLICY jECOT LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />1 2,000,000
<br />PRODUCTS-COMP/OPAGG
<br />2,000,00
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />AON
<br />UXUTSOLY
<br />72SBAAK7546
<br />4/1/2021
<br />41112022
<br />COMBINED SINGLE LIMIT adimt)$
<br />1000000
<br />BODILY INJURY Per arson
<br />$
<br />BODILY INJURY Per accident
<br />$
<br />ERRYY MOEA
<br />FTATOS
<br />$X
<br />A
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />72SBAAK7546
<br />41112021
<br />411/2022
<br />EACH OCCURRENCE
<br />$ 3,000,000
<br />AGGREGATE
<br />3,000,000
<br />DEO I X I RETENTION$ 10,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />YIN
<br />pAQN�Ygn/'MEETORIPARTNDED? CUTIVE
<br />(MFdOddto r In NHS EXCLUDED?
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />72WECEN4621
<br />81112021
<br />811/2022
<br />J( STATUTE �RH
<br />EL EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE - EA EMPLOYE
<br />1,000,000
<br />$
<br />E.L. DISEASE - POLICY LIMB
<br />1,000,000
<br />C
<br />Errors and Omissions
<br />MPL102277
<br />41112021
<br />4/1/2022
<br />$10,000 Deductible
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />*30 Day Notice of Cancellation except 10 Day Notice for Non -Payment of Premium
<br />City of Santa Ana, officers, agents, employees, and volunteers are named as additionally Insured on this policy pursuant to written contract, agreement, or
<br />memorandum of understanding. Such insurance as Is afforded by this policy shall be primary, and any Insurance carried by City shall be excess and
<br />noncontributory.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />ACORD 25 (2016/03)
<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 />AUTHORIZED REPRESENTATIVE
<br />©1988-2015 ACORD CORE 76u p&tJo,,
<br />The ACORD name and logo are registered marks of ACORD Rmkma,vq<mmru.��Iae<
<br />
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