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Dinitally rinnPrl D TE(M D/YYYY) ACORD® CERTIFICATE OF LIABILITYffilUpffb A i (D/16/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CO FE N TS PON TF'_ " RTIFICATE OLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGF AF C@VENIGE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONT CT E E 1 G1.a}eR(Y0�� REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. UU 11 06ED IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have DDITIO AL .NS ED11p vi i s be �j r e '� If SUBROGATION IS WAIVED, subject to the terms and conditions of the olic certain policies may rer,dire an en o s e to e t J policy, P Y 4 �� b � this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER (WC) Heffernan Insurance Brokers 1350 Carlback Avenue Walnut Creek CA 94596 CONTACT NAME: PHONE FAX A/C No Ext : 925-934-8500 A/C, No : 925-934-8278 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: National Fire Insurance Company of Hartford 20478 License#: 0564249 INSURED VISIINT-02 INSURERB: Continental Insurance Company 35289 Meridian Knowledge Solutions, LLC 80 Iron Point Circle, Suite 100 INSURERC: INSURERD: Folsom CA 95630 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 1483176704 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 6043522527 10/15/2021 10/15/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 15,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY � PRO- � LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N Y WC6043522561 10/15/2021 10/15/2022 X PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICE R/M EMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE (Mandatory in NH) $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Re: As Per Contract or Agreement on File with the Insured. The City, its officers, officials, employees, and volunteers are included as additional insureds (primary non contributory) on the General Liability policy per the attached, if required. Waiver of Subrogation is included on the General Liability and Worker's Compensation policies per the attached, if required. Notice of Cancellation is included on the General Liability policy, if required. The General Liability declarations page is attached, if required. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92702 . ,_.. RISIE kluagment DRR810R REVIEWED & APPROVED BY: © 1988-2015 ACORD °( ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD — Risk Management specialist