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ed <br />yTori Pierson <br />Tori Pierson Dateta2l02201.18 09.07:34-0BaO' <br />A�R o CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DDNYYY) <br />v12/2022 <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 endorsement(s). <br />PRODUCER Asero Insurance Services <br />200 N. Almaden Blvd. 3rd Floor <br />San <br />San Jose, CA 95110 <br />CNAME-ONTACT Asero Insurance Services <br />PHONE <br />866-966-8928 ac Na: 408-271-1802 <br />E-MAIL <br />ADDRESS: CertS aseroins.CAm <br />INSURE S AFFORDING COVERAGE <br />NAIC# <br />www.aseroins.com License No. OA91339 <br />INSURER A: Valley Fore Insurance Company <br />20508 <br />INSURED <br />Mark Thomas &Company, Inc. <br />2833 Junction Avenue, Ste 110 <br />INSURER B: Continental Casualty Company <br />20443 <br />INsuRERc: Continental Insurance Company <br />35289 <br />INSURER D: National Fire Insurance Co of Hartford <br />20478 <br />San Jose CA 95134 <br />INSURER E <br />INSURER F <br />CERTIFICATE NUMRER- <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 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 />ADDLSUBR <br />POLICYNUMBER <br />POLICY EFF <br />MMIDO <br />POLICY EXP <br />POUCMWDD <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ❑✓ OCCUR <br />�/ <br />Y, <br />6078951385 <br />9/15/2021 <br />9/15/2022 <br />EACH OCCURRENCE <br />$1000000 <br />DAMAGET ENTED <br />PREMISES Ee occurrence <br />$1000000 <br />MED EXP(Any ane arson) <br />$15000 <br />Deductible - None <br />PERSONAL &ADV INJURY <br />$1000000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY ✓�JECT FLOC <br />GENERAL AGGREGATE <br />$2,000,000 <br />GENL <br />PRODUCTS-COMP/OP AGO <br />$2000000 <br />$ <br />OTHER: <br />B <br />AUTOMOBILE <br />LIABILITY <br />✓ <br />✓ <br />6078951371 <br />9/15/2021 <br />9/15/2022 <br />CFOs BINE�DLSINGLE LIMIT <br />$1 OQO 000 <br />✓ <br />BODILY INJURY (Per person) <br />$ <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY ✓ AUTOS ONLY <br />✓ <br />BODILY INJURY (Par accident) <br />$ <br />PROPERTY DAMAGE <br />Pairs Icahn <br />$ <br />Com /Coll Ded: $1.000 <br />$ <br />C <br />✓ <br />uMSRELLALIAB <br />✓ <br />OCCUR <br />✓ <br />✓ <br />6078951399 <br />9/15/2021 <br />9/15/2022 <br />EACH OCCURRENCE <br />$9000000 <br />AGGREGATE <br />$9 0QQ QQQ <br />EXCESS LIAR <br />CLAIMS -MADE <br />DED I <br />I RETENTION$O <br />Deductible - None <br />$ <br />D <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'DABILITY YIN <br />� CERIMEM EREXCLU ED4 ECUTIVE ❑ <br />(Mandatory In NH) <br />If yes, describe under <br />NIA <br />✓ <br />6078951418 <br />9/15/2021 <br />9/15/2022 <br />PER oTH- <br />✓ STATUTE ER <br />E.L. EACH ACCIDENT <br />$1 QQQ QQQ <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />E.L DISEASE -POLICY LIMIT <br />$1 00O 000 <br />DESCRIPTION OF OPERATIONS below <br />A <br />A <br />Leased, Borrowed Or Rented <br />Equipment <br />Restoration of Media Coverage <br />(Valuable Papers) <br />6078951385 <br />6078951385 <br />9/15/2021 <br />9/15/2021 <br />9/15/2022 <br />9/15/2022 <br />Per Item Limit: $200.000 <br />Per Occurrence Limit: $200,000 <br />Limit(Deductible: $1,000,000/$5,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) <br />Re: Job# 21-00208 - SAGS Grant Applications <br />City of Santa Ana, its officers, employees, agents, volunteers and representatives as additional insureds. <br />Umbrella follows form. <br />The Workers Compensation / Employers Liability Deductible is none. <br />City of Santa Ana <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 />©1988-201 <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of AC <br />66237687 1 MNiMbl 1 21-22 Maeter CDI I Prabhjot Kau[ 1 1/12/2022 0:54:25 AN (PST) I Page 1 of 11 <br />S <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of AC <br />66237687 1 MNiMbl 1 21-22 Maeter CDI I Prabhjot Kau[ 1 1/12/2022 0:54:25 AN (PST) I Page 1 of 11 <br />f� <br />Wall, Mmal genDkiaim <br />ACORD CORP1L®�' <br />ORD 7du 7)&r sa <br />disk Ma,ugerm"Oniul Nde <br />