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as <br />Francine H. Villareal Villareal <br />^`� CERTIFICATE OF LIABILITY INSURANCE DATE <br />/22/rrv0 <br />2/7' 0' <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS <br />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 <br />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 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 />Wood Gutmann & Bogart Insurance Brokers <br />CONTACT <br />NAME: Candace Cordova <br />PHONE FA <br />Na - 714-824-8389 x A/C No: <br />License 0679263 <br />15901 Red Hill Ave., Suite 100 <br />ADoRess: ccordova@wgbib.com <br />Tustin CA 92780 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURER A: Continental Casual CO <br />INSURED CUNI-2 <br />Clinical Laboratory of San Bernardino, Inc. <br />INSURERS : American Cas CO of Reading PA <br />20427 <br />INSURERC: Continental Insurance Company <br />Geo-Monitor, Inc. <br />PO Box 329 <br />San Bernardino CA 92402 <br />INSURER D : Hartford Underwriters Ins Cc <br />INSURER E: United Financial Casualty Co <br />11770 <br />INSURER F <br />Cf1VFRA(:FC rcorrvnwrc .rr,.....-... ...__-_---. <br />"- ' ...... ­c. KeVI51UIN 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 />INSR AOOL SUER <br />LTR TYPE OF INSURANCE POLICY NUMBER MMIDDY EFF MMMDNYY LIMITS <br />B GENERAL LIABILITY Y 6072997663 2/1/2022 2/1/2023 EACH OCCURRENCE <br />x $ L000,000 <br />COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED <br />PREMISES Ea occurrence $100,000 <br />CLAIMS-MADElxl OCCUR <br />MED EXP (Any one person) $10,000 <br />PERSONAL & ADV INJURY $ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY FXI PRO- X1 LOC <br />GENERAL AGGREGATE $2.000,000 <br />PRODUCTS -COMPIOP AGE $2,000.000 <br />E <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS X NON -OWNED <br />005831362 <br />4/3/2022 <br />4/3/2023 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />1 0 0# <br />BODILY INJURY (Per person) <br />$ <br />IX <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />C <br />X <br />UMBRELLA LVIB <br />LIAB <br />ELITOOCSC�Partlent <br />CUE6Wfi281162 <br />2l1/2022 <br />2lt/2023 <br />EACH OCCURRENCEEXCESS <br />$5,000,000 <br />AGGREGATE <br />$5,000,000 <br />DED X RETENTION$10000 <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETO WPARTNEWEXECUTIVE <br />OFPCEWMEMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />NIA <br />72WECAE9PU9 <br />2/1/2022 <br />2/1/2023 <br />X WG siATU- OTH- <br />$ <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />E.L. DISEASE - EA EMPLOYE <br />$1,000,000 <br />A <br />DESCRIPTION OF OPERATIONS below <br />Environmental Professional Liabil <br />Claims Made Coverage <br />Deductible: $100.000 <br />EEH276170923 <br />V1/2022 <br />211/2023 <br />E.L. DISEASE- POLICY LIMIT $1.000,000 <br />Per Claim 3.000,000 <br />Aggregate 3,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />RE: All Operations usual to the insured's operations subject to the policy terms and conditions <br />City of Santa Ana, its officers, officials, employees and volunteers are named as additional insured on the General <br />contract subject to the terms and conditions of the policy. <br />Liability per attached as required by written <br />Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation per form to follow from carrier. <br />Primary and Non -Contributory applies on the General Liability per attached . <br />See Attached... <br />CFRTIFICATF M(V nFG <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 AUTHORRE EPRESENTATIVE <br />Santa Ana CA 92702 <br />PJA M#n igIaa..wwt �dDl w <br />s`,%g+ REVIEWED&APPRON®BY: <br />©1988-2010 ACORD Cl`` F4wc.�( R. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD®' <br />=�� Risk Management Analyst <br />