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Francine R. U91.4 siyaed by Franene <br />R V Il—I <br />)/illareal W.: 2022.011,16u351 <br />-00'00' <br />en.0 .I CL-D <br />LWESI <br />,Ill CERTIFICATE OF LIABILITY INSURANCE <br />ogr12412022 ) <br />vza/2ozz <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 <br />Orion Business Insurance and Risk Management Services, Inc. <br />1250 Corona Pointe Court, Suite 302 <br />Corona, CA 92879 <br />NOMEACT Lena West <br />PAIL NNo, Eat): (951) 281-5348 5346 FAX <br />No : <br />p-MAIL . Iwest@orionins.com <br />INSURERS AFFORDING COVERAGE <br />NAICY <br />INSURERA: Ohio Security Insurance Co. <br />24082 <br />INSURED <br />INSURER B: West American Ins Co <br />44393 <br />INSURERC:American Fire & Casualty Co. <br />24066 <br />M. Brey Electric, Inc. <br />INSURER D :Insurance Company of the West <br />27847 <br />P O Box 3159 <br />Beaumont, CA 92223 <br />INSURER E:Federal Insurance Company <br />20281 <br />INSURER F : <br />COVERAGES CFRTIFIr:ATF NIIMRFR- orximbrht NtIMnFo• <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 />TYPE OF INSURANCE <br />ADDLSUBR <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXPLTR <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE [X] OCCUR <br />X <br />BKS56377735 <br />11113/2021 <br />11113/2022 <br />EACH OCCURRENCE <br />11000,000 <br />DAMAGE TO RENTED... <br />500,000 <br />GLN'L <br />MED EXP (Any one on <br />$ 15,000 <br />PERSONAL$ ADV INJURY <br />1,000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY JELPT LOC <br />OTHER: <br />GENERALAGGREGATE <br />$ 2,000,000 <br />PRODUCTS - COMP/OP ADIS <br />$ 2,000,000 <br />8 <br />AUTOMOBILE <br />X <br />X <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOppSW <br />AUTOS ONLY X AfOJrNOS ONLY <br />X <br />BAW56377735 <br />11/1312021 <br />11/1312022 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />1,000,000 <br />$ <br />BODILY INJURY Per arson <br />$ <br />BODILY INJURY Per accident <br />$ <br />Pe�acciRtlent AMAGE <br />$ <br />C <br />X <br />UMBRELLA UA8 <br />EXCESS LIAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />ESA56377735 <br />1111312021 <br />1111312022 <br />EACH OCCURRENCE <br />$ 7,000,000 <br />AGGREGATE <br />71000,000 <br />DED RETENTION$ <br />D <br />WORKERS COMP NIA TIOITY <br />AND ANY PROPRIETOWPARTNEWEXECUTIVE YIN <br />pFFICERrMEMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />X <br />SD 505955400 <br />211212021 <br />211212022 <br />X PER <br />ERH <br />EL EACH ACCIDENT <br />1,OOQ000 <br />$ <br />E.L. DISEASE EA EMPLOYEE <br />$ 1,000,000 <br />E.L. DISEASE - POLICY LIMIT <br />1,0001000 <br />E <br />Commercial Umbrella <br />9364-34-82 <br />1111312021 <br />11113/2022 <br />Over Auto Only <br />1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, ma be attached If more space is required) <br />The City Of Santa Ana, Its officers, employees, agents, and representatives are I!SIM as additional insured as required by written contract per attached form. <br />Insurance is primary per attached form. 30 day notice of cancellation applies per attached form. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />CI Of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />t11 <br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE <br />,����� f-� Risk Malmgemml.DivieWt <br />(rfiW REve&m6MPRaAD8Y: <br />ACORD 25 (2016/03) @ 1988-2015 ACORD ClFes.- R' V&A � <br />Risk Management Analyst <br />The ACORD name and logo are registered marks of ACORD <br />