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Digitally signed by Francine R.
<br />Francine R. Villareal Villareal
<br />Date: 2021.03.29 07:45:47-07'00'
<br />CERTIFICATE OF LIABILITY INSURANCE
<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: H the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION MS WAIVED, subject to the terns 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 enciorsementfsh.
<br />PRODUCER
<br />Pacific Agents Alliance Insurance Agency; Julie Traughber Insurance Agent
<br />524 S Rosemead Blvd
<br />Pasadena _ _ _ CA 91107
<br />INSURED
<br />Argo Enterprises, Inc. dba: UniShieid
<br />599 4th St
<br />799-7061
<br />20443
<br />COMPANY Tf
<br />COVERAGES CERTIFICATE lJUMRFR• nCsaornm Eu Ie.evn.
<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 />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />_
<br />ry�n lu.m POLICYNUMBER IPOLICYYEFF MMIDD� 'V J LIMITS ILTR TYPE OF INSURANCE ADD --
<br />X
<br />COMMERCIAL GENERAL LIARILRY
<br />CLAIM MAOE FXOCCUR
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />$ 300,000
<br />PREMISES (Fa.cm,mencel
<br />MEDEXP(An oneperson)
<br />$ 10,000
<br />__-
<br />PERSONAL$ ADV INJURY
<br />Is 1,000,000
<br />A
<br />_ _
<br />X
<br />86024759005
<br />03/2412021
<br />03/24/2022
<br />S 2,000,000
<br />GEN'L
<br />X
<br />AGGREGATE LIMIT APPLIES PER
<br />POLICYF ECT LOG
<br />GENERALAGGREGAiE—
<br />PRODUCTS -COMP/ AGG_
<br />$ 2,000.000
<br />$
<br />OTHER.
<br />. AUTOMOBILE
<br />.-
<br />LIABILITY
<br />I
<br />COMBINIED-SINGUE LIMIT 4EaacGtlent
<br />$ 1,000,000
<br />ANYAUTO
<br />S -- _ -
<br />BODILY INJURY(Perpemon)
<br />B
<br />XHIRED
<br />OWNED V SCHEDULED
<br />AUTOS ONLY /� AUTOSSCHEDULED
<br />NON -OWNED
<br />ArOa ONLY AUTOS ONLY
<br />X
<br />64891191300
<br />10/16/2020
<br />10116/2021
<br />j
<br />aODILYINJURY Peramtlent
<br />1 _ I
<br />PROPERTY DAFAA-G`E_-
<br />(P_era itlenl
<br />$
<br />S
<br />S
<br />1
<br />X
<br />UMBREL A AB X OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />A
<br />EXCESS LIAB CLAIMS4eADE
<br />B6024759019
<br />03/2412021
<br />03242022
<br />2,000,000DED
<br />i AGGREGATE
<br />#ER
<br />RETENTION$ 10.000WORICERS
<br />COMPENSATIONAND EMPLOYERS'LIABILMY Y/ N
<br />ANY PROPRIETORIPARTNEWEXECUTNE
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />STATUTE
<br />•$
<br />.. ._..,
<br />EL EACH ACCIOEHT r---,.L_
<br />E.L. DISEASE_ EAEMPLOYE
<br />_ .. _
<br />(Maodalory in NH)
<br />If yeS, desoite, order
<br />S
<br />DESCRIPTION OF OPERATIONS below
<br />E.L DISEASE -POLICY LIMIT Is
<br />Employee Dishonesty,
<br />A Forgery and Alteration
<br />B6024759005 03/242021
<br />03/24I2022
<br />$1,000 deductible
<br />$1,000 deductible
<br />$25,000
<br />$25,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICES (ACORD 101, Addl$onal Remor'ns SCWduls, may W aeachad If more spar» is required)
<br />It is agreed that the City of Santa Ana, its officers, employees, agents, volunteers and representatives are named Additional Insureds and shall include, but not
<br />be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any
<br />act or occurrence arising out of Consultant's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. General
<br />Liability Fom1 CG (04113) is attached. This insurance is also Primary and Non -Contributory with respect to insurance or self-insurance programs maintained by
<br />the City. It is also agreed that 30 Days' Notice of Cancellation with 10 Days' Notice for Non -Payment of Premium in accordance with the policy provisions. All
<br />coverages are subject to the terns and conditions of each policy.
<br />City of Santa Ana
<br />Risk Management Division, 41h Floor
<br />20 Civic Center Plaza
<br />Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WfTH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />CA 92702
<br />© 1988.2015 ACI
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />s RiJeMMMgemgltD[xdpR
<br />REVIEWED&APPROVEDBY:
<br />gam' F IA4T 1G P, V1j&44d
<br />Risk Management Analyst
<br />01
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