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Tracv.. __. Digitally signed
<br />-
<br />tYVALrt.roPHacy Jacob M U
<br />Date:2022.08. I DATE(MMIDD/YYYY)
<br />,aco�ro CERTIFICATE OF LIABILITY
<br />IN 15:56:48 -07'0 6/1612022
<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 15 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 License#OC36861
<br />LONrncr BeVerlyGoyen
<br />Inland Empire-Alliant Insurance Services, Inc.
<br />685 E. Carnegie Dr Ste 265
<br />San Bernardino, CA 92408
<br />PHONE
<br />NN Ex[): (9D9 SB6-9661 FAX
<br />( ) (AIC. No):(909) 886-2013
<br />E-MAIESS. bgoyen@alliant.com
<br />INSURE S AFFORDING COVERAGE
<br />NAIL#
<br />INSURER A: Mt. Hawley Insurance Company
<br />37974
<br />INSURED
<br />INSURERB:AIIstate Insurance Company
<br />19232
<br />INSURER C : Cypress Insurance Company
<br />10855
<br />Quality Fence Company, Inc
<br />INSURER D
<br />14929 Garfield Avenue
<br />Paramount, CA 90723
<br />INSURER E
<br />NSURER 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 />INSR
<br />LTROLSUBR
<br />TYPE OF INSURANCE
<br />ADD
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE [XJ OCCUR
<br />j(
<br />MGLO195573
<br />10/1/2021
<br />10/112022
<br />EACH OCCURRENCE
<br />1 1,000,000
<br />DAMAGE TORENTED
<br />ENTEante
<br />60,000
<br />NED EXP (My one erem)
<br />5,000
<br />PERSONAL&ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER
<br />POLICVa JE�1-1 LOC
<br />OTHER: 5,000,000 per proj. cap.
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />X
<br />EBL AGG
<br />1,000,000
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOSpS
<br />AUTOS ONLY X ALLTNO5 ONLY
<br />X
<br />648909969
<br />10/1/2021
<br />10/1/2022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000 000
<br />$
<br />BODILY INJURY Per person)
<br />Ix
<br />BODILY INJURY Per accident
<br />fgerracakert MGE
<br />A
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />MXL0431792
<br />101112021
<br />101112022
<br />EACH OCCURRENCE
<br />$ 8,000,000
<br />AGGREGATE
<br />81000,000
<br />DEO I X RETENTION$ D
<br />C
<br />AWORKERS
<br />D EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNEREXECUTIVE YIN
<br />�FFICER/MEMBER EXCLUDED'
<br />Mantlalo In NR)
<br />DIf
<br />ESCdesc be under
<br />RIPTION OF OPERATIONS below
<br />NIA
<br />X
<br />QUWC202153
<br />101112021
<br />101112022
<br />X STA UTE ERH
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />E.L. DISEASE -EA EMPLOYE
<br />1,000'000
<br />E.L. DISEASE -POLICY LIMIT
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, ma be attached If more space is required)
<br />City of Santa Ana, officers, agents, employees, and volunteers are additional insures, primary and non-contributory as respects to general liability per
<br />endorsements attached; additional insureds, primary and non-contributory as respects to auto liability per endorsements attached; waiver of subrogation as
<br />respects to workers' compensation per endorsement attached. Cancellation notice per attached endorsements.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92720 AUTHORIZED REPRESENTATIVE
<br />�/ / ltlaleMougelledD'Iavan
<br />�u� Jryw� ;,''' REVIEWED ✓< APPROVED BY!
<br />ACORD 25 (2016/03) (/„-. ©1988-2015 ACORD Imo; T7'�'=
<br />The ACORD name and logo are registered marks of ACORD ® Risk Management Analyst
<br />
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