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<br />ACORo® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDIYYYY)
<br />�..�'1
<br />9/30/2021
<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 />CONTACT
<br />NAME: Maureen MOMO McDonald
<br />Arthur J. Gallagher & Co.
<br />Insurance Brokers Of CA., Inc.
<br />PHONE FAX
<br />818.539.8625 Arc No818.539,8725
<br />nooal : maureen mcdonald a' .com
<br />505 N Brand Blvd, Suite 600
<br />Glendale CA 91203 -
<br />INSURERS AFFORDING COVERAGE
<br />NAICIf
<br />INSURER A: Berkley Regional Insurance Company
<br />29580
<br />License# 0726293
<br />INSURED INTEHOU-03
<br />INSURER B : Service American Indemnity Company
<br />39152
<br />Interval House
<br />INSURER C: BCS Insurance Company
<br />38245
<br />P.O. Box 3356
<br />INSURER D :
<br />Seal Beach, CA 90740
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 1311633477 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.
<br />INTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />INSD
<br />Wye
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDIYYYY
<br />POLICY EXP
<br />MMIDD YY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIALGENERAL LIABILITY
<br />Y
<br />HH38525626-15
<br />10/1/2021
<br />10/1/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />AIMMADE � OCCUR
<br />CLS-
<br />DAM I T RENTED
<br />PREMISES Es occurrence
<br />$500,000
<br />MED EXP(Any on. person)
<br />$20,000
<br />PERSONAL B ADV INJURY
<br />$1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$3,000,000
<br />POLICY�PRO ❑LOC
<br />X JECT
<br />PRODUCTS - COMPIOP AGG
<br />$3,000,000
<br />$
<br />OTHER,
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />HHS8525626-15
<br />10/1/2021
<br />1O/1/2D22
<br />EOMaBBII tlEEDtSINGLE LIMIT
<br />$1,000,000
<br />BODILY INJURY (Par person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Par eccldan0
<br />$
<br />X
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />HHN8685444-12
<br />10/112021
<br />10/l/2022
<br />EACH OCCURRENCE
<br />$2,000,000
<br />AGGREGATE
<br />$2,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X I RETENTION$-n
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y/N
<br />ANYPROPRIETOR/PARTNERIEXECUTIVE ❑
<br />OFFICERIMEMB ER EXCLUDED?
<br />N/A
<br />V
<br />SATISO401010
<br />211/2021
<br />2/112022
<br />X STATUTE OERH
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS be.
<br />E.L. DISEASE POLICY LIMIT
<br />$1,000,000
<br />C
<br />Cyber Liability
<br />Claims -Made form
<br />Feb. Dar.: Full Prior Acts
<br />RPS-P-50219685M
<br />10/1/2021
<br />10/1/2022
<br />Limit
<br />Aggregate
<br />Retention
<br />$1,000,000
<br />$1,000,000
<br />$2,500
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schodula, maybe attached if more space is required)
<br />Policy: Crime Coverage
<br />Policy Term: 10/01/2021 to 10/01/2022
<br />Policy* UC14332375.21-079
<br />Carrier: Underwriters at Lloyd's, London
<br />Employee theft: Limit:$2,000,000 / Deductible: $25,000
<br />ERISA: Limit:$2,000,000
<br />Theft of money and securities: Limit:$2,000,000 / Deductible: $25,000
<br />Money and Securities: Limit:$2,000,000 / Deductible: $25,000
<br />See Attached...
<br />City of Santa Ana
<br />Attn: Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
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<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD -- �- ��' - -�
<br />
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