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I-rancine H. Villareal Villareal
<br />paw 202111.28 vz2ea uB'Car
<br />AcoRO� CERTIFICATE OF LIABILITY INSURANCE IDATIE(MM/DD/YYYY)
<br />1
<br />11/1812021
<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 endorsements .
<br />PRODUCER
<br />(8K) Heffernan Insurance Brokers
<br />7702 Meany Ave., Suite 102
<br />Bakersfield CA 93308
<br />CONTANAME,CTKar155 Perry
<br />PHONE E 661 48g-73HO Fix
<br />A/c Na:415-778-0301
<br />ADDRESS: kadsspAheffins.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC I/
<br />INSURERA: Federal Insurance Company
<br />20281
<br />'tense#: 0564249
<br />INSURED APPLTEC-03
<br />Applied Technology Group Inc
<br />4440 Easton Drive
<br />INSURER 9: Scottsdale Indemnity Company
<br />15580
<br />INSURERC: Insurance Company of the West
<br />27847
<br />INSU RER D:
<br />Bakersfield CA 93309
<br />NSURER E:
<br />INSURER F
<br />CERTIFICATE NUMBER: 891817176
<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 />LTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />INAn
<br />I WV0
<br />POLICY NUMBER
<br />POUCYEFF
<br />MWDO
<br />POLICY EXP
<br />M DD
<br />LIMITS
<br />A
<br />X
<br />COMMEROIALGENERALUABILITY
<br />CLAIMS -MADE EXI OCCUR
<br />Y
<br />36025222WCE
<br />7/l/2021
<br />7/1/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />DAMAGE TO R NTED
<br />PREMISES lEa a ...... neei
<br />$1,000,000
<br />MED EXP (Any one person)
<br />$10,000
<br />PERSONAL B ADV INJURY
<br />$1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY JEC LOC
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$2.000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />2173584639
<br />7/1/2021
<br />7/1/2022
<br />COMBINED ISINGLE LIMIT
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />IX
<br />BODILY INJURY amident)
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />X
<br />PROPERTYDAMAGE
<br />Per accident
<br />$
<br />A
<br />X
<br />UMSRELLADAB
<br />X
<br />OCCUR
<br />79894822
<br />7/1/2021
<br />7/1/2022
<br />EACH OCCURRENCE
<br />$5.000.000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED RETENTION
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY Y/N
<br />ANYPROPRIETORIPARTNEWEXECUTIVE
<br />OFFICER/MEMBEREXCLUDED?
<br />NIA
<br />Y
<br />WPL503611604
<br />3/22/2021
<br />3/22/2022
<br />X STER
<br />ATUTE ERH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />B
<br />Professional Liability
<br />EK13406391
<br />11/19/2021
<br />11/19/2022
<br />Per Claim B Agg
<br />$2,000,000
<br />Retention
<br />$10,000
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Re: Agreement Number N-2021-039. City of Santa Ana, its officers, officials, employees, and volunteers are included as an additional insured (primary and
<br />non-contributory) and includes completed operations on General Liability policy per the attached endorsements, if required. Waiver of Subrogation is included
<br />on Workers Compensation policy per the attached endorsements, if required. Cancellation notice endorsement for General Liability is attached, if required.
<br />This certificate supersedes previously issued certificate on 9/18/2021.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702 I'l„1thk MmBgmlentDititaat
<br />zerd REVIEWED&APPRO® V8Y;
<br />©1988-2015 ACORD CI `I,IINCTER" F,,;,K Vj(Au(
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ' Risk Management Analyst
<br />
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