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® J! CERTIFICATE OF LIABILITY INSURANCE <br />DATE(k1M/2022 Y) <br />�-� <br />,' <br />oz/zvzozz <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 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 endorsement(s). <br />PRODUCER <br />CONTACT Christy Dunlap <br />NAME: <br />ISU- Dunlap Agency <br />PHONE (714)838-3158 FAx (714)922-6157 <br />C No Exl : AIC, No <br />700 West 1 at St., Suite 8 <br />_ <br />a DO REss: Christy@dunlapins.com <br />INSURER(S) AFFORDING COVERAGE <br />NAICA <br />Tustin CA 92780 <br />INSURERA: Service American Indemnity Co. <br />INSURED <br />INSURER 8: <br />OneOC <br />INSURER C <br />1901 E. 4th Street, #100 <br />INSURER D <br />INSURER E : <br />Santa Ana CA 92705 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: CL22223U6421 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 />LTR <br />TYPE OF INSURANCE <br />A..L <br />INSD <br />o1JoK <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYYI' <br />POLICY E P <br />MMIDDIYYI'Y <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br />E <br />T PREMISES Ea occurrence <br />$ <br />CLAIMS -MADE OCCUR <br />MED ESP(An one person) <br />$ <br />PERSONAL &ADV INJURY <br />$ <br />GEN'LAGGREGATE <br />LIMITAPPLIES PER: <br />GENERALAGGREGATE <br />$ <br />POLICY ❑ PRO- <br />❑OC <br />JECT <br />PRODUCTS-COMP/OP AGG <br />$ <br />$ <br />OTHER: <br />1 <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLELIMIT <br />$ <br />Ea accident <br />ANYAUTO <br />BODILY INJURY (Per person) <br />$ <br />OWNED SCHEOULED <br />BODILY INJURY (Per accident) <br />$ <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />PROPERTY DAMAGE <br />Peraccldenl <br />$ <br />AUTOS ONLY AUTOS ONLY <br />UMBRELLALIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />If <br />EXCESS LIAR <br />CLAIMS -MADE <br />DEB <br />I I RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />PER OTH- <br />AND EMPLOYERS' LIABILITY YIN <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />A <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />N/A <br />SATI50407201 <br />03f01l2022 <br />03I01/2023 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />(Mandatory In NH) <br />lives, describe undo, <br />E.L. DISEASE -POLICY LIMIT <br />$ 1,000,000 <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) <br />Such insurance as Is afforded by this policy shall be primary, and any insurance carried by City shall be excess and noncontributory. Thirty (30) days notice <br />of cancellation required. Waiver of Subrogation Included. <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana <br />CA 92701 <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 />©1988.2015 ACOF <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />saar+nw Riek.MenegemattDtvufml. <br />8' �?'r `&.1 REVIEWEDn&APPROOVED BY, <br />1 1 f f"!� flEXYra� <br />Risk Management Specialist <br />