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TOYI Digitally signed by <br />Tori Pierson <br />PIPYSnII Date: 2022.017.12 <br />CLEAR-1 <br />OP ID: CG <br />.4c-®M15 CERTIFICATE OF LIABILITY INSURANCE <br />�� <br />DA07/0612022TE Y) <br />07/06/2022 <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 831-337-4661 <br />Clarion Pacific Insurance <br />2035 N.. Pacific Ave, <br />Santa Cruz, CA 95060 <br />Ryan Deane <br />CONTACT Coryn Gardiner <br />PHONE 631-337-4661 FAX 831-612.1810 <br />Me. Me,Eat): ac, No <br />Egc& :Coryn pac-ns .com <br />INSURIaNSI AFFORDING COVERAGE <br />NAICR <br />INSURER A: Travelers Property Casualty Co <br />25658 <br />SURER <br />earsource Financial Consulting <br />Terry Madsen <br />7960 Soque(Dr. ste: B363 <br />Aptos, CA 95003 <br />NSURERB:Nationwide Mutual Insurance Co <br />23787 <br />Philadel hia Indemni <br />INSURER C: P ty <br />18058 <br />INSURER D <br />NSURER E <br />NSURER F: <br />r.nVFRACFR CFRTIFIr1ATF NIIMRPP- RFVLgInM NIIMRFR• <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 />rypE OF INSURANCE <br />DL <br />SO <br />UBR <br />POLICY NUMBER <br />POUCY EFFIYYYY <br />POLICY EXPLTR <br />LIMITS <br />B <br />"COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE T OCCUR <br />X <br />ACP 3039102473 <br />12109/2021 <br />12/09/2022 <br />EACH OCCURRENCE <br />S 2,000,000 <br />DAMAGE TO RENTED <br />PREMISES (Ea oocturuncal <br />300,000 <br />B <br />MED EXP (My arm . <br />s 51000 <br />PERSONAL A ADV INJURY <br />S 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />X POLICY 0 PPEC LOG <br />GENERALAGGREGATE <br />S 410001000 <br />PRODUCTS-COMPIOP AGG <br />S 4,000,000 <br />OTHER: <br />B <br />AUTOMOBILE <br />LIABILITY <br />CEOMBBIINdEDISINGLE LIMIT <br />S 2,000,000 <br />BODILY INJURY Per Named <br />S <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />x <br />ACP 3039102473 <br />12/09/2021 <br />12/09/2022 <br />BODILY INJURY Per acodenl <br />S <br />X <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Par amdard <br />S <br />S <br />UMBRELLA UAS <br />OCCUR <br />EACH OCCURRENCE <br />5 <br />AGGREGATE <br />S <br />EXCESS LIAR <br />CLAIMS -MADE <br />DIED I I RETENTION S <br />S <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILItY YIN <br />OFFlGERRdEEIMBERIXCLUDE�4 ECUTIVE ❑NIA <br />(Mantlabryln NH) <br />If yes, desaibe under <br />DESCRIPTION OF OPERATIONS below <br />UB-SM759710-22.42-G <br />01101/2022 <br />01101/2023 <br />X PER H. <br />E.L. EACH ACCIDENT <br />S 1,000,000 <br />E.L. DISEASE - EA EMPLOYE <br />S 1'000'000 <br />E.L. DISEASE- POLICY LIMIT <br />1'000'000 <br />C <br />Professional Liab <br />PHS01673659 <br />12109/2021 <br />12/0912022 <br />Occurence <br />2,000,000 <br />Aggregate <br />2,000,000 <br />DESCRIPTION OF OPERATONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, maybe atiacbed it more apace Ia required) <br />RE: Citywide Indirect Cost Allocation Plan and Internal Service Funds Cost <br />Allocation Methodology. City of Santa Ana, its officers, employees, agents, <br />and representatives are Additional Insureds with respect to General <br />Liability and Auto Liability per the attached endorsements or as required by <br />written contract. Insurance is Primary and Non -Contributory. 30 day notice* <br />City of Santa Ana <br />Risk Management Division, <br />4th Floor <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />ACORD 25 (2016103) <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. <br />y- RLk Molrge"af Dfm <br />"G.J�" RenLvrRo a nrrRo�m ar. <br />©1988-2015 ACORD CO If` �%u ;%rr'oe <br />The ACORD name and logo are registered marks of ACORD - RakNu"aD<„a„m.>:aaa< <br />