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<br />Ejhjubmmz!tjhofe!cz!Upsj!Qjfstpo! <br />Ebuf;!3133/15/37!22;59;34! <br />Upsj!Qjfstpo <br />.18(11( <br />DATE(MM/DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE <br />04/25/22 <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 />PRODUCER <br /> E l l i e <br />NAME: <br />FAX <br /> PRIME INSURANCE SERVICES, INC.PHONE <br /> (949)450-2311 <br /> (949)450-2310 <br />(A/C,No): <br />(A/C,No,Ext): <br /> 9891 IRVINE CENTER DRIVE #160 E-MAIL <br /> ellie@primepolicy.com <br />ADDRESS: <br /> IRVINE, CA 92618-4319 <br />INSURER(S) AFFORDING COVERAGENAIC # <br /> License #:0D48024 <br />SENTINEL INSURANCE COMPANY 1 1 0 0 0 <br />INSURERA : <br />INSURED HARTFORD ACCIDENT & INDEMNITY 38920 <br /> ENGINEERING SOLUTIONS SERVICES INC. <br />INSURERB : <br /> propERTY & CAS INS. OF HF 2 2 3 5 7 <br /> SUDABEH SHOJA <br />INSURERC : <br />CFC Underwriting-Lloyds of Lon <br /> 23232 PERALTA DR., SUITE 112 <br />INSURERD : <br /> LAGUNA HILLS, CA 92653 <br />INSURERE : <br /> (949)637-1405 <br />INSURERF : <br />COVERAGESCERTIFICATENUMBER:REVISIONNUMBER: <br />THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVE BEEN ISSUED TO THEINSUREDNAMEDABOVEFOR THE POLICY PERIOD <br />INDICATED.NOTWITHSTANDINGANYREQUIREMENT, TERM ORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS <br />CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTO ALL THETERMS, <br />EXCLUSIONSAND CONDITIONS OFSUCH POLICIES. LIMITSSHOWN MAY HAVEBEEN REDUCED BYPAID CLAIMS. <br />ADDLSUBR <br />INSR <br />POLICYEFFPOLICY EXP <br />TYPE OF INSURANCELIMITS <br />LTR <br />INSDWVD POLICYNUMBER(MM/DD/YYYY)(MM/DD/YYYY) <br />COMMERCIAL GENERAL LIABILITY <br /> x <br />EACHOCCURRENCE$2,000,000 <br />DAMAGE TO RENTED <br /> X <br />CLAIMS-MADEOCCUR$ 1,000,000 <br />PREMISES(Eaoccurrence) <br />MED EXP (Any one person)$ 10,000 <br /> 2,000,000 <br /> A X x PERSONAL & ADV INJURY$ <br />8/19/20218/19/2022 <br /> 72SBAIT9447 <br /> 4,000,000 <br />GEN'LAGGREGATELIMITAPPLIESPER:GENERALAGGREGATE$ <br />PRO- <br /> x 4,000,000 <br />POLICYLOCPRODUCTS-COMP/OPAGG$ <br />JECT <br />$ <br /> <br />OTHER: <br />COMBINEDSINGLELIMIT <br />AUTOMOBILELIABILITY$ 1,000,000 <br />(Eaaccident) <br />ANY AUTO <br />BODILYINJURY(Perperson)$ <br />OWNEDSCHEDULED <br />BODILY INJURY (Per accident)$ <br /> x <br /> x <br />AUTOS ONLYAUTOS <br /> B x x <br /> 72UECCD2464 5/1/20225/1/2023 <br />HIREDNON-OWNEDPROPERTYDAMAGE <br />$ <br /> x <br />(Peraccident) <br />AUTOS ONLYAUTOS ONLY <br />$ <br />UMBRELLALIAB <br />OCCUREACHOCCURRENCE$ <br />EXCESS LIAB <br />CLAIMS-MADEAGGREGATE$ <br />DEDRETENTION$$ <br />PEROTH- <br />WORKERSCOMPENSATION <br /> X <br />STATUTEER <br />ANDEMPLOYERS'LIABILITY <br />Y / N <br /> 1,000,000 <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />E.L.EACH ACCIDENT$ <br />N / A <br /> C OFFICER/MEMBEREXCLUDED? Y x <br />8/20/20218/20/2022 <br /> 1,000,000 <br /> 72WECGG6484 <br />(Mandatory in NH) <br />E.L.DISEASE-EAEMPLOYEE$ <br />Ifyes,describe under <br /> 1,000,000 <br />DESCRIPTIONOFOPERATIONSbelowE.L.DISEASE- POLICY LIMIT$ <br />BUSINESS PERSONAL PROPERTY8/19/20218/19/2022 <br /> A 72SBAIT9447 B . P . P$14,300 <br /> X <br />8/29/20218/29/2022 <br /> D PROFESSIONAL LIABILITY PSK0132755912 P.LIABILITY $5M/$5M <br />DESCRIPTIONOF OPERATIONS / LOCATIONS / VEHICLES (ACORD101,Additional Remarks Schedule, may beattached if more space is required) <br /> City of Santa Ana, its officers, employees, agents and representatives are Additional Insureds <br />with respect to General and auto Liability per attached Endorsements as required by written <br />contract. Insurance is Primary and Non-Contributory. Waiver of Subrogation applies to Worker’s <br />Compensation. 30 day notice of Cancellation with 10 day notice for non-payment of premium in <br />accordance with the policy provisions. <br />ESS’s amended agreement number: 2017-224-01. <br />CERTIFICATEHOLDERCANCELLATION <br />ADDITIONAL INSURED: <br />SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE <br />City of Santa Ana <br />THEEXPIRATIONDATE THEREOF, NOTICEWILLBEDELIVEREDIN <br />Risk Management Division <br />ACCORDANCEWITHTHEPOLICY PROVISIONS. <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana, CA 92701 AUTHORIZEDREPRESENTATIVE <br />©1988-2015ACORDCORPORATION.Allrightsreserved. <br />ACORD25(2016/03)TheACORDnameandlogoareregisteredmarksofACORD <br /> <br />