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DiglGlly signed! EyTod Plennn
<br />Tori Pierson Dale: N, 2.03M 1053:14
<br />AB'OP
<br />`� �® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MWO22Y Y)
<br />02/NbDD22
<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. If
<br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this
<br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Ann Risk Services Central, Inc.
<br />Minneapolis MN Office
<br />CONTACT
<br />NAME:
<br />PHONE
<br />(866) 283-7122 F= Ms.): (800) 363-0105
<br />5600 West 83rd Street
<br />8200 Tower, Suite 1100
<br />E-MAIL
<br />ADDRESS:
<br />Minneapolis MN 55437 USA
<br />INSUPER(S)AFFOROING COVERAGE
<br />NAIC#
<br />INSURED
<br />INSURER A: Liberty Mutual Insurance Co.
<br />23043
<br />IBI Group, A California Partnership
<br />18401 Von Karman Ave, #300
<br />Irvine CA 92612-8543 USA
<br />INSURER B: Twin City Fire Insurance Company
<br />29459
<br />INSURER C: Beazley Insurance Company, Inc.
<br />37540
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: b/00917883Bb 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. Limits shown are as requested
<br />LTR
<br />TYPE OF INSURANCE
<br />Iwo
<br />we
<br />POLICY NUMBER
<br />POLICY
<br />ICIYLE
<br />MINOOIYYYY
<br />LIMITS
<br />A
<br />%
<br />COMMERCUIL GENERAL LIABILITY
<br />TB B7
<br />FACHOCCURRENCE
<br />$2,000,000
<br />CLAIMSMADE❑X OCCUR
<br />RENT
<br />PTNAZTS ERE TEff_nce
<br />$2,000,000
<br />MED E%P(Any one person)
<br />$2,500
<br />PERSONAL a ADV NJJURY
<br />$2,000,000
<br />GENL AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$5,000,000
<br />X POLICY ❑JECT ❑LOC
<br />PRODUCTS-COMPIOPAGG
<br />$2,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />AS1-B71-171213-011
<br />04/30/202104/30/2022
<br />COMBINED SINGLE LIMP
<br />Ea accident
<br />g2,000,000
<br />BODILY INJURY I Per person)
<br />X OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HXANYAUTO
<br />HIREDAUTOS NON OWNED
<br />ONLY ANDS ONLY
<br />BODILY INJURY (Per accident)
<br />PROPERTY DAMAGE
<br />Per acddent
<br />rodAnne X Non Owned Auto
<br />A
<br />JUMBRELLA
<br />LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIM&MADE
<br />100025514405
<br />SIR applies per policy terns
<br />04/30/2021
<br />& condi
<br />04/30/2022
<br />ions
<br />EACH OCCURRENCE
<br />$1,000,000
<br />AGGREGATE
<br />$1,000,000
<br />DEO I X
<br />RETENTION
<br />B
<br />WORKERSCOMPENSATIONAND
<br />EMPLOYERVLIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDEVI
<br />(Mandatory In NH)
<br />NIA
<br />41WEOL6H78
<br />04 30 2221
<br />04/30/2022
<br />X I PER STATUTE OTH-
<br />ER
<br />E.EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE EA EMPLOYEE
<br />$1,000,000
<br />If Yes describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />C
<br />E&O-PL-Primary
<br />V1F72F210501
<br />05/01/2021
<br />04/30/2022
<br />Per Claim Limit
<br />$2,000,000
<br />Claims Made
<br />Aggregate Limit
<br />$2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES (ACORD 101, Additional Remarks Schedule, may be smirched If more space Is required)
<br />As respects to policies, TSIB71171213021 (General Liability), AS1-B71-171213-011 (Auto Liability) and 100025514405 (Umbrella
<br />Liability); ADD Risk Solutions (U.S.) is generating and distributing this certificate in an administrative capacity. ADD Reed
<br />Stenhouse Inc. Toronto, Ontario Canada is the broker for the defined policies. The City of Santa Ana, its officers, officials,
<br />employees and volunteers are included as Additional Insured in accordance with the policy provisions of the General Liability
<br />and Automobile Liability policies. General Liability policy evidenced herein is Primary and Non -Contributory to other insurance
<br />available to Additional Insured, but only in accordance with the policy's provisions. A waiver of Subrogation is granted in
<br />favor of The City of Santa Ana, its officers, officials, employees and volunteers in accordance with the policy provisions of
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />-rem
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />City Of Santa Ana
<br />Risk Management Division
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center P1aZa
<br />Santa Ana CA.. 92702 USA
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<br />©1988.2015 ACORD COR
<br />IfA,Mana9envrt o..,wadr
<br />ACORD 25 (2016/03)
<br />The ACORD name and logo are registered marks of ACORD
<br />
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