|
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 />
|