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Tori Pierson.,.:20 02J5039:Person
<br />1-0909
<br />ACORO® CERTIFICATE OF LIABILITY INSURANCE
<br />14� 2/1/2023
<br />DATE(MMMDNYYY)
<br />F
<br />1 1/27/2022
<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 endorsement(s).
<br />PRODUCER Lockton Insurance Brokers, LLC
<br />777 S. Figueroa Street, 52nd FL
<br />CA License #OF 15767
<br />Los Angeles CA 90017
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />C No Et)' A!C No:
<br />EMAIL
<br />ADDRESS:
<br />(213) 689-0065
<br />INSURERPSI AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Crum & Forster Specialty Insurance Co
<br />44520
<br />INSURED Rincon Consultants, Inc.
<br />1462718 18ONAshwoodAve.
<br />INSURER B: Hartford Fire Insurance Company
<br />19682
<br />INSURER C:StarstoneNational Insurance Company
<br />25496
<br />Ventura CA 93003 -
<br />INSURER D : -
<br />INSURER E :
<br />INSURER F:
<br />COVERAGES RINCOOI CERTIFICATE NUMBER: 16059509 REVISION NUMBER xxTtYRYY
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE OD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT HIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AMS,EXCLUSIONS
<br />AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE-MM
<br />ADDL
<br />SUER
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDD
<br />;THE
<br />LIMITSAXCOMMERCUILGENERA-
<br />IABILITY
<br />CLAIMS -MADE aOCCUR
<br />Y
<br />Y
<br />EPK-133853
<br />2/12021
<br />2/l/2023
<br />EACH OCCURRENCE
<br />$
<br />DAMAGE TO-RE—NMD
<br />PREM SES Eoeu.nence
<br />$
<br />X
<br />MED EXP (Any one person)
<br />$
<br />SIR: $50,000
<br />X
<br />I P&I
<br />PERSONAL & ADV INJURY
<br />$ 3000000
<br />GENL AGGREGATE LIMIT APPLIES PER:
<br />POLICY JEST LOC
<br />GENERALAGGREGATE
<br />$ 4000000
<br />PRODUCTS —COMP/OPAGG
<br />$ 4000000
<br />$
<br />OTHER:
<br />E
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />72UENOL5481
<br />2/12022
<br />2/1/2023
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1 000 000
<br />BODILY I NJURY(Par person)
<br />$ C)C)
<br />ANY AUTO
<br />I
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY( Per accident)
<br />$ XX7IXXX}(
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per actltlard
<br />$ XXXXX70C
<br />Comp./Coll. Ded
<br />s 1,000
<br />A
<br />UMBRELLA LIM
<br />X
<br />OCCUR
<br />N
<br />N
<br />EFX-119720
<br />2/l2022
<br />2/I/2023
<br />EACH OCCURRENCE
<br />s 5000000
<br />AGGREGATE
<br />$ 5.000.000
<br />X
<br />EXCESS LIAB
<br />CLAIM&MADE
<br />DED X RETENTION$ 10,000
<br />1 $ xxxxxxx
<br />C
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YIN
<br />Y
<br />T10220329
<br />2/1/2022
<br />2/I/2023
<br />PER OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />ANY PROPRIETOR/PAMNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />E.L. DISEASE -EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1000000
<br />A
<br />Contractors Pollution Liab
<br />N
<br />N
<br />EPK-133853
<br />2/1/2021
<br />2/1/2023
<br />Limit $3,000,000/$4,000,000
<br />E&O Liab.
<br />Limit: $3,000,000/$4,000,000
<br />Retro Date: 12/9/1994
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, maybe attached if more space is required)
<br />Cyber Liability: Cartier: AXIS Surplus Insurance Company, Policy No. Renewal Policy No. P-001-000809984-01, Policy Term: 2/12022-2/l/2023, Limit S5,000,000, SIR: S75,000; Cyber Excess
<br />Liability: Carrier: Evared an Insurance Company, Policy No. MKLV3XCY000065, Policy Term: 2/12022-2/l2023, Limit S5,000,000. The City of Santa Ana and Community Development Agency
<br />and their officers, employees, agents and volunteers are an Additional Insured to the extent provided by the policy language or endorsement issued or approved by the insurance carrier. Waiver of
<br />Subrogation applies per attached endoesement(s) or Policy language. Insurance provided to Additional Insured(s) is primary and non-contributory as per the attached endorsement or policy language.
<br />Excess policy follows General Liability, Auto Liability and Employers Liability form. Notice of Cancellation applies per the applicable policy language or endorsements.
<br />16059509
<br />City of Santa Ana
<br />Risk Management Divison
<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 />II IEVILviso 4APea0vm Br:
<br />e1 di It3 %u arGxJe.r
<br />©1 88.201 C D C( � RhI.Ala,dq.,,a�raRiwaae
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD v N
<br />
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