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<br />, lls R CERTIFICATE OF LIABILITY INSURANCE
<br />�/
<br />DATE /14/20IY1
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<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME:
<br />Western Republic Insurance Services
<br />PHONE 714.536.0500
<br />AIC No Ea[: A/C, No):
<br />t9900 Beach Blvd
<br />ADDRESS: dustin@wrinsurance.com
<br />Suite Fl
<br />INSURER(S) AFFORDING COVERAGE
<br />NAICIf
<br />Huntington Beach CA 92648
<br />INSURER A: SECURITY NATL INS CO
<br />19879
<br />INSURED
<br />INSURER B : EVANSTON INS CO
<br />35378
<br />Golden Meters Service, Inc.
<br />INSURER C : INFINITY SELECT INS CO
<br />20260
<br />14812 Hunter Lane
<br />INSURER D : NATIONAL UNION FIRE INS CO OF PITT, PA
<br />19445
<br />INSURER E
<br />Midway City CA 92655
<br />1 INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />(MMIODYYYY
<br />MWDDNYYYI
<br />LIMITS
<br />B
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />Y
<br />Y
<br />M1CLV5PBC003744
<br />09/09/2021
<br />09/09/2022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PREMISES Ea occurrence)
<br />$ 100,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL B ADV INJURY
<br />$ 1,000,000
<br />GEN-L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-
<br />JECT LOC
<br />OTHER:
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMP/OP AGO
<br />$ 2,000,000
<br />CGL
<br />$
<br />C,JANYAUTO
<br />AUTOMOBILE
<br />LIABILITY
<br />ALL OWNED SCHEOULED
<br />AUTOS AUTOS
<br />AUTOS NON -OWNED
<br />/� AUTOS
<br />Y
<br />Y
<br />504-6I002-9619-001
<br />04/15/2021
<br />04/15/2022
<br />UUMBINIEU BINULt, LIMI I
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY(Per person)$
<br />BODILY INJURY(Per accident
<br />)HIRED
<br />$
<br />Per accident)
<br />$
<br />D
<br />X
<br />UMBRELLA LIAR
<br />EXCESS LIAR
<br />[I
<br />OCCUR
<br />CLAIMS -MADE
<br />BE023632132
<br />09/09/2021
<br />09/09/2022
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />$ 4,000,000
<br />DED
<br />I I RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />ND EMPLOYERS' LIABILITY YIN
<br />OFFICER/MEMBER EXCLUDE/D?ECUTIVE❑NIA
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS be.
<br />Y
<br />SWC1329933
<br />03/07/2021
<br />03/07/2022
<br />V -
<br />/� STATUTEANY ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Those usual to the insured's operations. City of Santa Ana, officers, agents, employees, and volunteers are named as additional insured per
<br />the attached CG 20 10 07 04 & CG 20 37 07 04. Waiver of subrogation applies per the attached CG 24 04 05 09 and WC 04 03 06.
<br />Insurance is primary and non-contributory per the attached CG 20 0104 13. A 30 day written notice of cancellation is applicable.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<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.
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<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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