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<br />CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/1'YY7)
<br />8/30/2021
<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 pollcy(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 endorsementtsi-
<br />PRODUCER CONTACT
<br />NAME: The
<br />3697 t. Diablo Design Professionals Insurance Services, LLC PHONE
<br />3697 Mt. Diablo Blvd Suite 230 uc a Ext:
<br />Lafayette CA 94549 EAODDRRLEss. Ce
<br />INSURED
<br />MIG, Inc.
<br />800 Hearst Ave
<br />Berkeley CA 94710
<br />25682
<br />COVERAGES CERTIFICATF NItMRF0-o00g773g3S
<br />- . _- — V IOIvre NUMOC l:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR
<br />THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT
<br />TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ILTR
<br />TYPE OFINSURANCE
<br />BR
<br />POLICYNUMBER
<br />MMI0DYEFF fYYMMhO11L0
<br />YEXP
<br />LIMITS
<br />B
<br />X
<br />COMMERCIALGENERALLWBILIY
<br />Y
<br />Y
<br />6801HB99998
<br />8/312021
<br />8131/2022
<br />CLAIMS -MADE ff] OCCUR
<br />EACH OCCURRENCE
<br />$1,000,000
<br />PREMISES EacccuRenca
<br />$1,000,000
<br />X
<br />Contracluel List
<br />MED E%P (Any one person)
<br />$10,000
<br />brcludeel
<br />PERSONAL It ADV INJURY
<br />$1,000,DDO
<br />AGGREGATE LIMIT APPLIES PER:
<br />711
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GEN'L
<br />PRODUCTS-COMP/OP AGO
<br />$2,000,000
<br />POLICY ja 1 I LOC
<br />OCHER:
<br />C
<br />AUTONYAUTLIgBILRY
<br />V
<br />V
<br />ggpg579947
<br />BrJ72021
<br />61312022
<br />CO klent)SINGLEUMIT
<br />(Ea accident
<br />$1,000,000
<br />BODILY INJURY (Par Person)
<br />$
<br />OWNED
<br />OWNED SCHEDULED
<br />BODILY INJURY (PeremMeM)
<br />$
<br />Ix
<br />AUTOS ONLY AUTOS
<br />HIRED AUTOS ONLY X NON-OWNED
<br />ONLY
<br />PROPERTY DAMAGE
<br />$
<br />Per acddenl
<br />e
<br />X
<br />UMBRELLA LIAB
<br />N
<br />OCCUR
<br />Y
<br />Y
<br />CUPOH768762
<br />8/312021
<br />W312022
<br />EACH OCCURRENCE
<br />$10.000.000
<br />AGGREGATE
<br />$10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DEO X RETENTION $
<br />$
<br />B
<br />WORKERSCOMPENSATION
<br />ANDEMPLOYERS'LIABILITY
<br />Y
<br />UB2L553909
<br />81312021
<br />BI312022
<br />ER OTH-
<br />X STATUTE ER
<br />YIN
<br />ANYPROPRIETOWPAR NEREXECUTIVE
<br />OFRCERIMEMBEREXCLUDED? Li
<br />NIA
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />(Mandatory6d.rin NH)
<br />If yes, descdba antler
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1.000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,0DO
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />Professional Uabllliy
<br />N
<br />Y
<br />AEC904725003
<br />8/312021
<br />8/312022
<br />Each Claim
<br />$3,000,000
<br />Annual Aggregate
<br />$5,000,000
<br />DESCRIPTIONOFOPE MONS/LOCATIONSIVEMCLES(ACORD101, Additional Remark, schedule, may ba a .d Rmore apace is required)
<br />Umbrella Liability policy is a follow -form underlying General Liability/Auto Liability/Employers Liability.
<br />RE: Santa Are Parks, Facilities, Trails and Open Space Master Plan City of Santa Ana, Risk Management, it's officers, employees, agents, representatives,
<br />and volunteers are named as additional Insureds as respects general and auto liability as required per written contract or agreement. General and Auto Liability
<br />are Primary/Non-Contributory per policy form wording.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana 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 />'RESENTATNE RhkManymaattNwbn '
<br />RknEwm6Arpgov®Br -.
<br />1<
<br />©1988.2015 ACORD C( rsauM.r.,arawiralA.dr --
<br />ACURO 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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