|
Francine R. D,„nly,gn�ayr,mrnee.
<br />Real
<br />�1 INTER-2 °11°'C°'
<br />D011201202YY)
<br />ovzo/zozz
<br />CERTIFICATE OF LIABILITY INSURANCE
<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 endorsements .
<br />PRODUCER 916-773-3800
<br />ISUFrancis-Pinneylns soca
<br />2266 Lava Ridge Court
<br />Roseville, CA95661
<br />Eric Moore
<br />cxME?DT ISU Francis -Pinney Ins. Svrs
<br />PHONE 916-773-3800 FAX 916-773�484
<br />Arc,No, EXt : AIC, No):
<br />ADORE,,. certificates@isuors.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Security National Insurance Co
<br />19879
<br />INSURED
<br />Inter -Pacific Inc.
<br />1421 Ave, Suite
<br />INSURER B: West American Insurance Co.
<br />Ohio Security Ins. Co
<br />INSURER C: y
<br />INSURER D : American Fire & Casualty Co.
<br />Tustin, CA 92760
<br />A92
<br />INSURER E
<br />NSURER F:
<br />COVFRAGFS CFRTIFICATF NIIMRFR• 01=111cinki Mnllanco.
<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 IXEL
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUB
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY E%P
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE LX] OCCUR
<br />X
<br />BKW56144681
<br />09/08/2021
<br />09108/2022
<br />EACH OCCURRENCE
<br />11000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occumence)
<br />$ 500,000
<br />MED EXP (Any one arson
<br />15,00D
<br />PERSONAL &AOV INJURY
<br />1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑jEa LOG
<br />GENERA -AGGREGATE
<br />1 2,000,000
<br />GEN'L
<br />X
<br />PRODUCTS - COMP/OP AGO
<br />21000,000
<br />OTHER
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)X
<br />$ 1,000,000
<br />BODILY INJURY Perperson)
<br />ANY AUTD
<br />X
<br />BAS62698905
<br />01/29/2022
<br />01/29/2023
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />PROPERTY DAMAGE
<br />Peraccidenl
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />D
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />S 41000,000
<br />X
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />ESA56144681
<br />09/08/2021
<br />09/0812022
<br />AGGREGATE
<br />41000,000
<br />DIED RETENTION$
<br />S
<br />1
<br />A
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS' LIABILITY yyVV �/llNNNNI
<br />ANY PROPRIETOWPARTNER/EXECUTIVE u
<br />OFF[CEMMEMBE) EXCLUDED? u
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />X
<br />SWC1342257
<br />06/0912021
<br />06/0912022
<br />1C I RPE�RTUTF OTH-
<br />EL. EACH ACCIDENT
<br />1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />1,6DU,DU9
<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 />30 day prior written notice of cancellation. 10 day notice for non payment
<br />of premium.
<br />The City of Santa Ana, its officers, officials, employees and volunteers are
<br />included as additional insured on the General Liability per attached
<br />endorsement form. Commercial Auto is named as additional insured
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />ACORD 25 (2016103)
<br />SANTAII
<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 />"-"L A_7 Risk MoragMtmEDivf®IaL
<br />agei REVIEWED&APPROVED BY:
<br />©1988-2015 ACORD C 83Mi:111f1L' �nEar,�.re R.
<br />The ACORD name and logo are registered marks of ACORD I I'" -� -' Risk Managemem AnRy,t
<br />
|