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Francine R. Villareal oiniuiN naea h, P—me n. 1111n. Hale; 3011A6.1516:)a91.7re CARDINT-01 VSUNDIN . la Q CERTIFICATE OF LIABILITY INSURANCE �� °ATE,MMI°° YYY) 618/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER License 00767776 c CT Long Beach, CA-HMBD Ins Services -HUB International Insurance Services Inc. 3633 E Broadway Suite 200 Long Beach, CA 90803 CAI° Na, Eat: (562) 439-9731 ac , No: E- INSURERS AFFORDING COVERAGE NAIC N INSURER A:Philadelphia lndemni Insurance Company 18068 INSURED INSURER B : INSURER C : Card Integrators Corporation INSURER D: 3625 Serpentine Drive Los Alamitos, CA 90720 INSURER E ; INSURER F COVERAGES CERTIFICATE NUMBER! RFVISInN NHMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OFINSURANCE ADDLSUBR INSD MIDpOLICYNUMBER POLICY EFF POLICY EXP LIMITS A X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X X PHPK2280816 6/612021 6/612022 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 900000 MED EXP (Any one p erson $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT ]LOG OTHER: GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 A AUTOMOBILE IxANY LIABILITY AUTO OWNED SCHEDULED AUTOS ONLY AUOTOGU Ep 278S ONLY X AUTOS ONNLV PHPK2280816 6/6/2021 616/2022 COMBINED SINGLE LIMIT arrIdarh $ 1,000,000 BODILY INJURY Par eson) S BODILY INJURY Perecddenl Pe�accleent AMAGE UMBRELLA LIAB EXCESS LIAR I OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OFFICER/MEMBEER EXCLUDED4 ECUTIVE ❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA IPER OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE E.L. DISEASE- POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) City of Santa Ana, officers, employees, agents, volunteers, and representatives are Inclued as Additional Insured per attached Primary and Non -Contributory per form PI-GL-005 (07112). Cancellation endorsement form PI-CANXAICH-002 (05111) attached. City of Santa Ana Risk Management Division 20 Civic Center Plaza, Floor 4 Santa Ana, CA 92701 ACORD 25 (2016103) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE R1�EP-R1ESENTATIVE 4*'1 ©1988-2015 ACORD The ACORD name and logo are registered marks of ACORD T rA§YM Z t4C€N14/,L. Risk MAR$gement Analyst