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) on 1 (e rs o n Date: 2022.062210:39:52 <br />w'00' <br />ACk0 D CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDNYYY) <br />06/13/2022 <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 endorsements . <br />PRODUCER <br />CAE CT Julia Traughber, CISR, CLCS <br />Pacific Agents Alliance Insurance Agency; Julie Traughber Insurance Agenc <br />524 S Rosemead Blvd <br />PaDNE (818) 203-2209 1 uc xo: (826) 799-7051 <br />ADDRESS: julie(@julietraughberins.com <br />ADDRESS, 9 <br />INSURERS AFFORDING COVERAGE <br />NAIC / <br />Pasadena CA 91107 <br />NSURERA: CONTINENTAL CASUALTY COMPANY <br />20443. <br />INSURED <br />INSURER B: ALLSTATE INSURANCE COMPANY <br />19232 <br />Argo Enterprises, Inc. dba: UniShield <br />INSURER¢; <br />599 4th St <br />INSURER D : <br />INSURER E : <br />San Fernando CA 91340 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 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 />ILSR <br />TYPE OF INSURANCE <br />ADDL <br />BUSH <br />im <br />POLICY NUMBER <br />k1 POLICY EFF <br />FOLICDJYYYYl EXPlam <br />YYYI <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE X OCCUR <br />EACH OCCURRENCE <br />$ 1,000,000 <br />T <br />DAMAGE ORENPREMISES Eaoccmenos <br />$ 300,000 <br />MED EXP(Any one person) <br />$ 10,000 <br />PERSONALBADVINJURY <br />$ 1,000,000 <br />A <br />X <br />X <br />B6024769005 <br />03/24/2022 <br />03/24/2023 <br />GENL <br />X <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑ JET � LOC <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS-COMP/OP AGO <br />$ 2,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT a at <br />cciden <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />B <br />OWNED CHEDULED <br />AUTOS ONLY /� AUTOS <br />HIRED V No. ED <br />AUTOSONLY nAUTOSONLV <br />X <br />648911913 <br />10/16I2021 <br />10/16/2Q22 <br />X <br />BOOILV INJURY er acdtlant <br />(P ) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />X <br />UMBRELLA LIAR <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 2,000,000 <br />AGGREGATE <br />$ 2,000.000 <br />A <br />EXCESS LEASCLAIM&MADE <br />B6024759019 <br />03/24/2022 <br />03/24/2023 <br />LIED X RETENTIONS 10,000 <br />$ <br />WORKERS COMPENSATION <br />". MPLoVERS•rJ 1a TfN <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? El <br />N/A <br />PER OTfi- <br />BT <br />$ <br />E.L. EACH ACCIDENT <br />E.L. DISEASE- EA EMPLOYEE <br />$ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS boles, <br />EL DISEASE -POLICY LIMIT <br />$ <br />Employee Dishonesty, <br />$1,000 deductible <br />$25,000 <br />A <br />Forgery and Alteration <br />B6024759005 <br />03/24/2022 <br />03/24/2023 <br />$1,000 deductible <br />$25,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K more space Is required) <br />It is agreed that the City of Santa Ana, its officers, officials, employees and volunteers are named Additional Insureds on the CGL policy with respect to liability <br />arising out of work or operations performed by or on behalf of the Contractor including materials, parts or equipment fumished in connection with such work or <br />operations. General Liability Form CG 2026 (04/13) is attached. This insurance is also Primary and Non -Contributory with respect to insurance or self- <br />insurance programs maintained by the City per Form No. CG2001 (01104) attached. Any insurance or self-insurance maintained by the Entity, its officers, <br />officials, employees or volunteers shall be excess of the Contractor's insurance and shall not contribute with 0 per CG204 (10/93) attached. It is also agreed <br />that 30 Days' Notice of Cancellation with 10 Days' Notice for Non -Payment of Premium in accordance with the policy provisions. All coverages are subject to <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana <br />© 1988.2015 ACORD CC <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />