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Dig itallysigned by Tori Pierson
<br />Tori Pierson Date: 1.11.1111109:07:00
<br />-0T00'
<br />1
<br />'4�f 'ems CERTIFICATE OF LIABILITY INSURANCE
<br />L.I IY Y
<br />DAT/1712DlYYYI�
<br />3177/2022
<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(les) 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 endorsemen s .
<br />PRODUCER License # 958967
<br />c TACT Lynn Gillow
<br />Johnston Lewis Associates, Inc.
<br />5600 New King, Ste. 210
<br />Troy, MI 48098
<br />�,vc°, No Ext ; (24$) 687-7748 FAX No
<br />E•MAI lynng@jlains.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC 0
<br />INSURER A: Cincinnati Insurance Company
<br />10677
<br />INSURED
<br />INSURER B :
<br />INSURER C :
<br />Mobile Ed Productions, Inc.
<br />INSURER D ;
<br />26018 W. Seven Mile Road
<br />Redford, MI 48240
<br />INSURER E :
<br />INSURER F :
<br />CnVERAr.FS r_FRTIFIr_ATF MtIMR1=0- 0011101M 1101FRA12=12.
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL UABIL17Y
<br />CLAIMS -MADE F_X] OCCUR
<br />ENP 0059666
<br />11112022
<br />11112023
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE PREMISETO RENTED
<br />500,000
<br />MED EXP (Anyoneperson)
<br />5,000
<br />PERSONAL & ADV INJURY
<br />1,000,000
<br />GEMLAGGREGATE LIMITAPPLIESPER,
<br />POLICY El ja F] LOG
<br />GENERAL AGGREGATE
<br />2,000,000
<br />PRODUCTS -COMPIOPAGG
<br />2,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />MBINED SINGLE LIMIT
<br />$
<br />BODILY INJURY(Per Orson
<br />$ 1,000,040
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY ALITOpSyy�Ep
<br />ENP 0059666
<br />•11112022
<br />11112023
<br />Ix
<br />BODILY INJURY Peraccident
<br />$
<br />Pe�accdent AMAGE
<br />$
<br />AUTOS ONLY Ix AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAS
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />1,000,t100
<br />EXCESS LIAS
<br />CLAIMS -MADE
<br />ENP 0059666
<br />11112022
<br />11112023
<br />DED I I RETENTION$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERlEXECUWE YIN
<br />FICERIMEMggEEREXCLUDED? �N
<br />andatory In NH)
<br />If yos, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />EWC 0294345
<br />1/112022
<br />11112023
<br />X PER LITE OTH-
<br />STAT ER
<br />E.L. EACH ACCIDENT
<br />1 '���'���
<br />E.L. DISEASE- EA EMPLOYE
<br />1,0U0,000
<br />E.L. DISEASE -POLICY LIMIT
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, maybe attached If more space Is reulred`
<br />The City of Santa Ana, Its officers, officials, employees, agents and volunteers are Included Additional Insureds with respects to General Liability, per policy
<br />forms & conditions, when required by written contract. Blanket Additional Insured applies when required by written contract.
<br />Such Insurance as is afforded by this policy shall be primary, and any Insurance carried by Santa Ana Unified School District shall be excess and
<br />noncontributory.
<br />A 30 Day Notice of Cancellation will be provided with exception for non-payment where as a 10 Day Notice of Cancellation will be provided.
<br />Waiver of Subrogation applies to the General Liability and Workers Compensation policies, when required by written contract.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />The City of 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
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE
<br />UVEe7 DlD i
<br />r� Itr+,±PEirAE➢7 & APPRSY9�'.
<br />ACORD 25 2016103 c
<br />{ ) O 1988-2015 ACORD CORI
<br />The ACORD name and logo are registered marks of ACORD R,sk Ma ge tC1,ictlhole
<br />
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