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<br />Ejhjubmmz!tjhofe!cz!Upsj!Qjfstpo! <br />Ebuf;!3133/15/17!25;42;32! <br />Upsj!Qjfstpo <br />.18(11( <br />BLUEMAN-02CGEREZ <br />DATE (MM/DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE <br />4/5/2022 <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(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 endorsement(s). <br />CONTACT <br />License # 0H18131 <br />PRODUCER <br />NAME: <br />PHONEFAX <br />Momentous Insurance Brokerage, A Marsh & McLennan Agency LLC <br />(818) 933-2700(818) 933-2701 <br />(A/C, No, Ext):(A/C, No): <br />Company <br />E-MAIL <br />5990 Sepulveda Blvd., #550 <br />ADDRESS: <br />Van Nuys, CA 91411 <br />INSURER(S) AFFORDING COVERAGENAIC # <br />Acceptance Casualty Ins Co10349 <br />INSURER A : <br />INSURED <br />California Automobile Insurance Company38342 <br />INSURER B : <br />Lloyd's of London Underwriters <br />INSURER C : <br />Blueray Management LLC <br />P.O. Box 12529 <br />INSURER D : <br />Newport Beach, CA 92658 <br />INSURER E : <br />INSURER F : <br />COVERAGESCERTIFICATE NUMBER: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 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 />INSRADDLSUBRPOLICY EFFPOLICY EXP <br />TYPE OF INSURANCEPOLICY NUMBERLIMITS <br />LTRINSDWVD(MM/DD/YYYY)(MM/DD/YYYY) <br />1,000,000 <br />A <br />COMMERCIAL GENERAL LIABILITY <br />X <br />EACH OCCURRENCE$ <br />DAMAGE TO RENTED <br />100,000 <br />CLAIMS-MADEOCCUR <br />X <br />BRK0001819003/24/20223/24/2023 <br />$ <br />PREMISES (Ea occurrence) <br />X <br />Excluded <br />MED EXP (Any one person)$ <br />Included <br />PERSONAL & ADV INJURY$ <br />2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ <br />PRO- <br />2,000,000 <br />X <br />POLICYLOC <br />PRODUCTS - COMP/OP AGG$ <br />JECT <br />OTHER:$ <br />COMBINED SINGLE LIMIT <br />1,000,000 <br />B <br />AUTOMOBILE LIABILITY <br />$ <br />(Ea accident) <br />X <br />ANY AUTO BA0400000667123/24/20223/24/2023 <br />BODILY INJURY (Per person)$ <br />OWNEDSCHEDULED <br />AUTOS ONLYAUTOSBODILY INJURY (Per accident)$ <br />PROPERTY DAMAGE <br />HIREDNON-OWNED <br />(Per accident)$ <br />AUTOS ONLYAUTOS ONLY <br />$ <br />UMBRELLA LIABOCCUR <br />EACH OCCURRENCE$ <br />EXCESS LIABCLAIMS-MADE <br />AGGREGATE$ <br />DEDRETENTION$ <br />$ <br />PEROTH- <br />WORKERS COMPENSATION <br />STATUTEER <br />AND EMPLOYERS' LIABILITY <br />Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT$ <br />N / A <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />E.L. DISEASE - EA EMPLOYEE$ <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ <br />Sexual MisconductMR2289883/24/20223/24/2023 <br />Sexual Misconduct100,000 <br />C <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />City of Santa Ana, Risk Management, it’s officers, employees, agents, representatives, and volunteers are included as additional insureds as required by <br />written contract. General Liability policy is primary & non-contributory. Waiver of subrogation applies under the General Liability per form attached. <br />Thirty (30) day prior written notice of cancellation will be provided. <br />CERTIFICATE HOLDERCANCELLATION <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, Risk Management Division <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana, CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016/03)© 1988-2015 ACORD CORPORATION. All rights reserved. <br /> <br />The ACORD name and logo are registered marks of ACORD <br /> <br />