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Francine R, DlyaalgelgnM by Finadn<n
<br />m9a,<al
<br />Villareal oa,<:zsn.eazs,seensorso
<br />CALIFORPRO CARD
<br />A� QM CERTIFICATE OF LIABILITY INSURANCE
<br />DATOf/YYY)
<br />s129/2zs/zo21
<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 License # 0262636
<br />920 CT Patty Ebeling
<br />United Agencies
<br />3267 E. Guest] Ave, Suite 100
<br />Ontario, CA 91761
<br />PHONE FAX
<br />IAIC, No Ext: 909) 296-3299 Ac, No): (929) 295.7377
<br />AIL , aft drisinc.com
<br />NSU ERB AFFORD NG COVERAGE
<br />NAIC0
<br />INSURERA: Navigators Specialty Insurance Company
<br />36056
<br />INSURED
<br />INSURER B: Travelers Property Casualty Company of America
<br />25674
<br />INSURER C:_RSU_I Indemnity _Comoany-,-„-„_,_,--
<br />22314
<br />California Professional Engineering Inc.
<br />19062 San Jose Avenue
<br />La Puente, CA 91748
<br />INSURER D;
<br />...._._._....___.____._...._-_....._....._.....
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NIIMRFR• acvlslnN Nulan®co.
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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 SUSJECTTO ALL THE TERMS, '
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPEOFINSURANCE
<br />INSD
<br />MD
<br />POLICY NUMBER
<br />MOUC YEF
<br />POLICYEFF
<br />POLICY EXP
<br />MOLIC YEXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIARILITY
<br />EACH OCCURRENCE
<br />11000,000'.
<br />CLAIMS -MADE ® OCCUR
<br />X
<br />CE210GL2396411C
<br />5/19/2021
<br />5/1912022
<br />DAMAGE TO RENTED
<br />$ 60,000
<br />Owner's & Contractor
<br />MED EXP An one erson
<br />X
<br />$
<br />—
<br />PERSONAL &ADV INJURY
<br />__ _ _
<br />$ 1,000,000'.
<br />GENT AGGREGATE LIMIT APPLIES PER
<br />[X] Pr
<br />GENERAL AGGREGATE
<br />2,OOQOOD''.
<br />PRODUCTS - COMP/OP AGO
<br />$ 2,000,000'..
<br />POLICY LOC
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />11000,000I
<br />BODILY INJURY, Per person)$
<br />ANY AUTO
<br />N261807
<br />5/1912021
<br />$11912022
<br />-'-"""--
<br />ONMED SCHEDULED
<br />1XX
<br />AIUITEEO��SONLY AUTTNO��ryS1WWNMFop
<br />BODILY INJURY per accident
<br />'
<br />Pe�aiR nl AMAGE
<br />$ _
<br />Affl%ONLY X ASTOSONFCV
<br />DetlucOblo $0
<br />C
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000'I
<br />X
<br />AGGREGATE
<br />$ 5'000r000�'I
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />NHA251650
<br />6/1912021
<br />611912022
<br />DED X RETENTION$ 1g,gDD
<br />'
<br />$
<br />g
<br />WORKERS
<br />X E
<br />IS
<br />NDEMAYIN
<br />ANY PROPMETOMPARTNEREXECUTIVE
<br />619021
<br />SH9/2022
<br />EL. EACH ACCIDENT
<br />$ 1,OOQ000I,
<br />gQFFICE eOT M6rl EXCLUDED? ❑Y
<br />In NH)
<br />NIA
<br />(Mantlatory
<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 />g
<br />Contractor Equipment
<br />7P2991896600
<br />511912021
<br />5/19/2022
<br />Leased/Rented
<br />100000'
<br />B
<br />Installation Floater
<br />7P2991896600
<br />5/19/2021
<br />5/19/2022
<br />Limit
<br />250:000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required)
<br />The City of Santa Ana, its officers, employees, agents, and volunteers are additional insureds with regard to liability and defense of suits arising from the
<br />operations and uses performed by on or behalf of the named Insured per attached forms CG20100413 & CG20370413. With respect to claims arising out of the
<br />operations and uses performed by on or behalf of the named insured, such Insurance as is afforded by this policy is primary and is not additional to or
<br />contributing with any other insurance carried by or for the benefit of the additional Insureds per attached form CG20010413. This insurance applies separately
<br />to each insured against whom claim is made or suit Is brought except with respect to the company's limits of liability. The Inclusion of any person or
<br />organization as an Insured shall not affect any right which such person or organization would have as a claimant If not so included per form NPC7110811.
<br />SEE ATTACHED ACORD 101
<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 />AUTHORIZED REPRESENTATIVE
<br />©1988.2015 A
<br />The ACORD name and logo are registered marks of ACORD
<br />FM41111WP, MA
<br />Risk Management Hnallyst
<br />
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