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mgIWHI sIlud by F,andne P.
<br />A-2021-107-06 B Francine R. Villareal vita es
<br />e.2@Lm.II lo:4ls5-0r00'
<br />FAMIFOR-01 DaiRTONG
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DAT/30/2DIY
<br />63012021
<br />1
<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 License # OM10410
<br />MAcT
<br />ArmstronglRobitaillelRiegle Business and Insurance Solutions
<br />830 Roosevelt, Suite 200 _
<br />Irvine, CA 92620 _
<br />PHONE FAX
<br />AIC, No, Ext: (949) 381-7700 (wc, No):(949) 487.6151
<br />o A ass: arrinfo@aleragroup.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC p
<br />INSURER A:Philadelphia lndemnit Ins Co
<br />18058
<br />INSURED
<br />INSURER 6:COm West Insurance Com an
<br />12177
<br />INSURER C:
<br />Families. Forward
<br />8 THomas -
<br />Irvine, CA 92618
<br />INSURER D
<br />INSURER E:
<br />INSURER F:
<br />C❑V IF A r:FS PFRTIFIPATF M11RAPPG•
<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 />TYPE OF INSURANCE
<br />ADOL
<br />p
<br />5UBR
<br />D
<br />-
<br />POLICY NUMBER
<br />POLICY EFF
<br />(I
<br />POLICY EXP
<br />(Mmlafflm)
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ® OCCUR
<br />X
<br />PHPK2293752
<br />7/1/2021
<br />711/2022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO REoNTED nce
<br />$ 100,000
<br />MED EXP An one arson
<br />$ 20,000
<br />PERSONAL B ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY jEOT LOC
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />GEN'L
<br />PRODUCTS - COMPIOP AGG
<br />S 3,000,000
<br />A
<br />AUTOMOBILE
<br />X
<br />X
<br />OTHER:
<br />LIABILITY
<br />ANYAUTO
<br />OWNED SAUTOSCHEDULED
<br />'AUTOS ONLY SCHEDULED
<br />2 S ONLY X AUTOS ONLY
<br />PHPK2293752
<br />7/1/2021
<br />7/1/2022
<br />SEXUAL ABUSE
<br />(OeBINEDI SINGLE LIMIT
<br />$ 1,000,000
<br />$ 1,000,000
<br />BODILY INJURY Perperson)
<br />$
<br />BODILY INJURY Per accident
<br />$
<br />peOacEgg AMAGE
<br />A
<br />X
<br />UMBRELLA LIA6
<br />EXCESS LIAB
<br />_ X
<br />OCCUR
<br />CLAIMS -MADE
<br />PHUS774554
<br />711/2021
<br />7/112022
<br />EACH OCCURRENCE _ - -
<br />- - - 4,000,000
<br />AGGREGATE
<br />4,000,000
<br />LED X RETENTION$ 10,000
<br />B
<br />WORKERS
<br />ND EMPLOYERSELIABIIL011Y V I N
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />(Man RIMEMDERg EXCLUDED? 1:1NIA
<br />(Mandatory In NH)
<br />If yyes describeunder
<br />DESCRIPTION OF OPERATIONS below
<br />WCV550516100
<br />711/2021
<br />-
<br />71112022
<br />X STA ER
<br />E, L. EACH ACCIDENT
<br />$ O00000
<br />E.L. DISEASE -EA EMPLOYE
<br />11000,000 $
<br />E.L. DISEASE -POLICY LIMIT
<br />1.000,000
<br />A
<br />Professional (E&O)
<br />PHPK2293752
<br />7/1/2021
<br />7/112022
<br />Occurrence
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is rec olred)
<br />The City of Santa Ana, Its officers, employees, agents, and representatives are named as Additional Insured on Primary and Non-Contribory basis with
<br />respect to General Liability coverage per attached forms as required in a written contract, agreement, or memorandum of understanding.
<br />30 Days Cancellation Notice unless 10 Days for Non -Payment.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL
<br />BE DELIVERED IN
<br />Risk Management Division
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />c� . ftlekManayvmlentl)(vi
<br />° REVIEWED&APPROVED
<br />ACORD 25 (2016103)
<br />O 9 8-2015 ACORD C
<br />g I� " f4mll-
<br />'r t M
<br />The ACORD name and logo are registered marks of ACORD
<br />I
<br />_
<br />Risk ManilgeHlentanz
<br />
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