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Samantha M. Digitally signed by Samantha M. <br />lambert <br />Lambert Datin 2021.10.0511:1103 grab <br />ACORO® CERTIFICATE OF LIABILITY INSURANCE <br />k.ii <br />DATE(MMIDonYYY) <br />1 9/28/2021 <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 />PRODUCER <br />RBN Insurance Services <br />303 E Wacker Dr Ste 650 <br />Chicago IL 60601 <br />CONTACT <br />NAME: Symons White <br />PHONE 312-856-9400 FAX <br />No). 312-856-9425 <br />EMD rsess: swhite rbninsurance.com <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURERA: Hartford Fire Insurance Co. <br />19682 <br />INSURED SAFELLC411 <br />InterP.O. Boestx <br />18330 Consulting Group <br />P.O. Box 18330 <br />INSURER B: Hartford Casualty Insurance Co <br />29424 <br />INSURERC: Great American E&S Ins. Co. <br />37532 <br />INSURER D: Twin City Fire Insurance Co. <br />29459 <br />Boulder CO 80308 <br />INSURER E: Bridqeway Insurance Company <br />12489 <br />INSURER F: Navigators Secial Ins. Co. <br />36056 <br />COVERAGES CERTIFICATE NUMBER: 1135316927 RFVISION N1IMRFR- <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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDLSUBR <br />111I <br />VIVO <br />POLICYNUMBER <br />POLICY EFF <br />MMMD <br />POLICY EXP <br />MM/DO/YYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />Y <br />Y <br />83UENZV3951 <br />10/3/2021 <br />10/3/2022 <br />EACH OCCURRENCE <br />$1,000,000 <br />OAMAGETO RELATE <br />PREMISES Ea occurtenca <br />$300,000 <br />NED ESP (Anyone person) <br />$10,000 <br />PERSONAL B ADV INJURY <br />$1.000.000 <br />AGGREGATE LIMIT APPLIES PER: <br />PNOLICV JECTPRO- <br />LOC <br />GENERALAGGREGATE <br />$2,000.000 <br />GENT <br />X <br />PRODUCTS - COMPIOPAGG <br />s2,000,000 <br />$ <br />OTHER <br />B <br />AUTOMOBILE <br />LIABILITY <br />Y <br />Y <br />83UENPY9100 <br />1013/2021 <br />10/3/2022 <br />COMBINED SINGLE LIMIT <br />En accident) <br />$1,000.000 <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLYNAUTOS <br />Ix <br />BODILY INJURY (Per accident) <br />$ <br />HIRED - NON -OWNED <br />AUTOS ONLYAUTOS ONLY <br />PROPERTVDAMAGE <br />Per accident <br />$ <br />F <br />UMBRELLAUAB <br />X <br />OCCUR <br />C H21 EXC885600 IC <br />10/3/2021 <br />10/3/2022 <br />EACH OCCURRENCE <br />$5,000,000 <br />AGGREGATE <br />$5,000,000 <br />X <br />EXCESS LIAR <br />CLAIMS -MADE <br />DID X RETENTIONS It <br />$ <br />D <br />WORKERS COMPENSATION <br />AND EMPLOY'ERS'LIABILnY YIN <br />Y <br />83WECE0623 <br />5/12/2021 <br />5/12/2022 <br />X STER ATUTE OTRH- <br />E.L. EACH ACCIDENT <br />$1.000.000 <br />ANYPROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBEREXCLUDED1 <br />NIA <br />E.L. DISEASE - EA EMPLOYEE <br />$1.000.000 <br />(Mandatory in NH) <br />If its, describe under <br />E.L. DISEASE -POLICY LIMIT <br />$1.000.000 <br />DESCRIPTION OF OPERATIONS below <br />C <br />E <br />Professional Liability <br />Excess Liab(2nd) Layer <br />TER 2861558 <br />8E-A7-XL-0002079-00 <br />10/3/2021 <br />10/3/2021 <br />10/3/2022 <br />10/3/2022 <br />Each Claim/Aggrogate <br />Each OcGAggregate <br />10,000,000 <br />5,000.000 <br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />The City of Santa Ana, its officers, employees, agents and representatives are Additional Insured on a primary and non-contributory basis as respects the <br />General Liability and Auto Liability as required by written contract. A Waiver of Subrogation applies in favor of the Additional Insured as respects the General <br />Liability, Auto Liability, and Workers Compensation as required by written contract. 30 Days Notice of Cancellation applies. 10 Days Notice for Non -Payment of <br />premium applies. <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 ACCORDANCE WITH THE POLICY PROVISIONS. <br />Risk Management Division <br />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92702 <br />� `"'�`—� 1BdtMM1#�rlei116irwe <br />f1EvtevEO&MPRov®BY: <br />01988-2015 ACORD C <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ffilw1w' Risk Management Superani <br />