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A-2021-110-02A <br />Tori Piersonoeet2'00l]A5d06152099-O0J00' <br />ACORO CERTIFICATE OF LIABILITY INSURANCE <br />Ill <br />DATE(MMIDDIYYYY) <br />1 5/26/2022 <br />THIS CERTIFICATE IS ISSUED ASA 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($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder In lieu of such endorsement(s). <br />PRODUCER <br />CONTACT <br />NAME: <br />Driscoll & Driscoll Insurance Agency, Inc. <br />PHONE (661)266-9390 FA/C No: I66n266-9391 <br />E-MAIL Carts@DriscollandDriscoll. corn <br />ADDRES: <br />S <br />41235 llth St West, Suite B <br />INSURERS) AFFORDING COVERAGE <br />NAIL B <br />INSURER A: Nautilus Insurance Company <br />Palmdale CA 93551 <br />INSURED <br />INSURERB:KeY Risk Insurance Company <br />INSURER C: Insurance Company of the West <br />Chambers Group, Inc - <br />INSURERD: <br />5 Hutton Center Drive, Suite 750 <br />INSURERS <br />Santa Ana CA 92707 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: CL2252619958 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDLSUBR <br />POLICYNUMBER <br />POLICY EFF <br />MMDO <br />POLICYEXP <br />MM/DDIYYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE Fx_1 OCCUR <br />EACH OCCURRENCE <br />$ 1,000,000 <br />DAMAGE TO RENTED <br />PREMISES HE, occurrence <br />$ 100, 000 <br />MED EXP (Any one person) <br />$ 10, 000 <br />X <br />Y <br />ECP2026303-14 <br />6/1/2022 <br />5/12/2023 <br />PERSONAL &ADV INJURY <br />$ 1,000,000 <br />GEN'L AGGREGATE LIMITAPPLIES PER: <br />X POLICY O JPECT F7 LOC <br />GENERALAGGREGATE <br />$ 2,000,000 <br />PRODUCTS - COMP/OP AGO <br />$ 2,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />- . <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 1,000,000 <br />X <br />BODILY INJURY (Per person) <br />$ <br />B <br />ANYAUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />10 BAP203p739- <br />6/1/2022 <br />5/12/2023 <br />BODILY INJURY Per accident <br />( ) <br />$ <br />HIREDAUTOS NON -OWNED <br />AUTOS <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />$ <br />.UMBRELLA LIAB' <br />-X <br />OCCUR <br />- - - - - <br />- <br />EACH OCCURRENCE <br />$ 10,000,000 <br />X <br />AGGREGATE. <br />$ 101000 000 <br />,A <br />EXCESS LIAB <br />CLAIMS -MADE <br />- -- <br />DED_.I RETENTION -$ <br />Is <br />FFX2026322-14 <br />6/1/2022 <br />5/12/2023 <br />WORKERS COMPENSATION <br />YIN <br />- <br />X STATUTE <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ 1 OOO,ODO <br />C <br />ANY PROPRIETORIPARTNER/EXECUTIVE <br />OFFICE MEMBER EXCLUDED? El <br />(Mandatory In NH) <br />If es, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />NVE 3055233 02 <br />5/12/2022 <br />5/12/2023 <br />E.L. DISEASE-EAEMPLOYEE <br />I $ 1,000,000 <br />E.L. DISEASE -POLICY LIMIT <br />I $ 1 000 ODO <br />A <br />Contr Pollution Liability <br />ECP2026303-14 <br />6/1/2022 <br />5/12/2023 <br />Per Ocol AOU 1 M / 2 M <br />A <br />Professional Liability <br />ECP2026303-14 <br />6/1/2022 <br />5/12/2023 <br />Clelms Made 1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, AddlUonal Remarks Schedule, maybe attached If more space is required) <br />Blanket Waiver applies to the General Liability Policy per form If ECP 1260 01 21. Blanket Primary & <br />Non -Contributory wording applies to the General Liability Policy per form N ECP 1246 01 21. Blanket <br />Additional Insured applies to the General Liability Policy per form 8 ECP 1246 01 21 & ECP 1248 01 21; in <br />favor of: City of Santa Ana, officers, agents, employees, and volunteers. 10 day Notice of Cancellation <br />for Non-payment -& 30 day for all other. <br />HOLDER <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLIO i,tMMgonmtTk <br />THE EXPIRATION DATE THEREOF, NOTICE WILL E fiAPPRCNE <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Dri3Co11, Sr/DM <br />ACORD 25 (2014101) <br />INS025 (201401) <br />The ACORD name and logo are registered marks of ACORD <br />