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CERTIFICATE OF LIABILITY INSURANCE <br />DATE (II WDDYYYYY) <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 I THE ISSUING IINSURER(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 right's to the certificate holder in lieu of such endorsementts). <br />CONTACT <br />PRODUCER Bolton Insurance' Services LLC NAME: <br />3475 E. Foothill Blvd., Suite 190 PHONE <br />0AX••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••............•••••••••••••••••. <br />626 799 7000 <br />INS: N a. IN§)••581•.1.7;••••••. <br />Pasadena, CA 91107 E-MAIL <br />wwww boltonco.00m 6004772 <br />INSURED <br />Atkinson, Andelsonl, Loya, Ruud & Romo <br />12800 Center Court Drive ##300 <br />Cerritos CA 90703 <br />INSURER A: Vigilant Insurance Com <br />INSURER B : Federal Insurance Corn <br />INSURER .G : <br />INSURER DB <br />INSURER E <br />COVERAGES CERTIFICATE NUMBER: R74201'11 REVISION NUMBER - <br />20397 <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 CAR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE. TERIMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN I REDUCED BY PAID CLAIMS. <br />INNR I ADDL SUSR., 06DdY EFF POLICY EXP <br />LTR TYPE OF INSURANCE INSD vivo POLICY NUMBER MM DD Y'YY MM1DD YYYY <br />LIMITS <br />A �✓ COMMERCIIALGENERA/LLIABILITY 35344557 4/112022 4/11/2023 <br />EACH OCCURRENCE <br />00 <br />CLAIMS -MADE OCCUR <br />� "� <br />l'R�� �F��p 9��PnJ <br />_$1,000 <br />� 1 eIQD(�a� 00 -- - <br />MED„IXP sAnynPsal$„1„�.p,t1t <br />PERSONAL & AOV INJURY <br />_$1,000,QI00 <br />GEN'LAGGREGATE LIMITAPPLIESPER: <br />GENERAL AGGREGATE <br />$2,000,0'00 <br />... <br />POLICY PRO- <br />'r�LCiI•v <br />PItL1lU!IvTS COMPfOP AGG <br />'$Included <br />OTHER: <br />$ <br />B <br />AUTOMOBILE <br />----- <br />LIABILITY <br />73508514 <br />411l2022 <br />4/11/2023 <br />COMBINED SINGLE UM IT <br />LEa arcidentj <br />$1 ��� �'�� <br />ANY AUTO <br />BODILY INJURY (Per person) <br />$ <br />--------- <br />.................. <br />O WNED SCHEDUL.E.I3 <br />AUTOS ONLY AUTOS <br />......... .................. ................. ...... <br />BODILY INJURY (Per accid�ent) <br />---------------------------------------------------------------- <br />'$. <br />AMAGE <br />v� <br />AUTOS ONLY ,!`;�.. AUTOS ONLDY <br />.$. .... ........ <br />B <br />✓ <br />UMBRELLALIAB OCCUR <br />79757104 <br />4/112022 <br />4/11/2023 <br />EACH OCCURRENCE <br />$15,000, 0 <br />E CESS LIAR' CLAIMS -MADE <br />AGGREGATE' <br />15atlttltltl <br />DIED RETENTION $ <br />$ <br />L? <br />WORKERS COMPENSATION <br />71732870 <br />4/112022 <br />411112023 <br />PER <br />AND EMPLOYERS' LIABILITY YIN <br />STATUTE ER1I <br />------- <br />...... ......... ................. <br />ANYPROPRIETORIPARTNER/E—W I NE <br />NIA............................. <br />El. EACH ACCIDENT" <br />$1 O�1(}PQ'(jI� <br />OFF ICE MMEMBER EXCLUDED? N <br />Mandate In NK <br />lDES <br />E L DISEASE <br />'$ <br />desc i9N Oibe F OPERATIONS tietaw' <br />RIPT <br />E.L. DISEASE POLICY <br />� 1 000 000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1101, Additional Remarks Sohedulo, may W attached If more space is required) <br />Re: Client #10302, AALRR-Cerrlltos.000302.10086, Reference ##N-2021-066. <br />CITY OF SANTA ANA <br />RISK MANAGEMENT DIVISION <br />20 CIVIC CENTER PIw. <br />SANTA ANA CA 92701 <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 r qY..Dmalon <br />�M9 �, ,/�f°R('SV/EE3 8Yf <br />,I <br />William A. Lewis <br />01985-2015 ACORD Ct Ri,k n...ge—tCe oaIade <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />6742e1.33. 1 AAID'k.N. 1 22-23 Master Cer¢i.,rfi.ca'te I Dej!a Gonzales 1 3f29/2022 1.e:510'].4 AM tPDTY I Page 2 of 3. <br />