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Francine R. D,l,aiy eg„ed by Francine
<br />Kv laraal
<br />Illareal DateIDRoz 03 nea:4s
<br />LIEBCAS-07 OMORATHERS
<br />,d►co02®' CERTIFICATE OF LIABILITY INSURANCE
<br />DA 0
<br />11/2/272/2022
<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
<br />PRODUCER
<br />IeI44ndorsement(s).
<br />NRMEACT June Samarin
<br />Narver Asssociates Insurance Agency
<br />423 McGroarty Street
<br />San Gabriel, CA 91776
<br />PHONE FAX
<br />AIC, No, eat); (626) 943-2237 (AIC, No):
<br />ki%AfiSs. jsamarin@narver.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A -Sentinel Insurance Company, Ltd
<br />11000
<br />INSURED
<br />INSURER Federal Insurance Company
<br />20281
<br />INSURER C:AS en Specialty Insurance Company
<br />10717
<br />Liebert Cassidy Whitmore
<br />INSURER D: Benchmark Insurance Company41394
<br />6033 W. Century Blvd. 5th Fir
<br />Los Angeles, CA 90045
<br />INSURER E
<br />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 />INSR
<br />LTRINSD
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />Me
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />I OCCUR
<br />X
<br />X
<br />72SBAAK0318
<br />1211412021
<br />1211412022
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />DAMACLAIMS-MADE
<br />PREMISES aoccurDnCe
<br />$ 1,000,000
<br />MED UP An one erson
<br />$ 10,000
<br />PERSONAL& ADV INJURY
<br />$ 2,000,000
<br />GENL AGGREGATE LIMIT APPLIES PER:
<br />POLICY JECT LOC
<br />GENERALAGGREGATE
<br />$ 4,000,000
<br />PRODUCTS - COMPIOP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ac en
<br />COMBINED SINGLE LIMITU4,000,000
<br />BODILY INJURY Per emon
<br />ANY AUTO
<br />72SBAAK0318
<br />1211412021
<br />12114/2022
<br />OWNED SCHEDULED
<br />AUTOS ONLY AU
<br />BODILYBryODILY INJURY Per accident
<br />PerOac Jt Y A GE
<br />X
<br />AUTOS ONLY X A�TNOS ONL�
<br />A
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />AGGREGATE
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />72SBAAK0318
<br />1211412021
<br />12/14/2022
<br />DEO I X RETENTION$ 10,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS LIABILITY
<br />Y
<br />ANY PROPRIETORIPARTNERA XECUTIVE ❑
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NlA
<br />X
<br />7175.0595
<br />41112021
<br />41112022
<br />X PER OTH-
<br />TAT E
<br />E.L. EACH ACCIDENT
<br />1,000,QQQ
<br />$
<br />E.L. DISEASE -EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPNON OF OPERATIONS below
<br />EL DISEASE -POLICY LIMIT
<br />1,000,000
<br />$
<br />C
<br />Professional Liab.
<br />LRA9AF821
<br />12/1012021
<br />1211012022
<br />Each Claim
<br />5,000,000
<br />D
<br />Cyber Liability
<br />BLU-CB-QG5CGLUOB
<br />12/14/2021
<br />1211412022
<br />Aggregate
<br />3,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, me be attached If more space Is require
<br />City of Santa Ana, its officers, officials, employees and agents are Additional Insurer as respects attached Genera Liability Form SS 00 08, perwritten
<br />contract or agreement. Such insurance is primary and non-contributory as per attached General Liability form SS 00 08. Waiver of subrogation applies as per
<br />attached General Liability form SS 00 08 and Workers Compensation form WC 90 03 75.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cityof Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Fir
<br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE RIdcMRrmgernvdl)nidl>n
<br />+ry RhvlEwm6APPR/N®BY:
<br />��� `'lvallJll#,1? f�Lr'r~wr R. V:(Lrn.�l
<br />ACORD 25 (2016/03) ©1988.2015 ACORD C
<br />Risk Mnnagerrtent Analyst
<br />The ACORD name and logo are registered marks of ACORD
<br />
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