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CERTIFICATE OF LIABILITY NSURANCE: Digitally sigl
<br />edl06/20/2022
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<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND COMRSIM k1QHTS OF IFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AII THE COVchA(�*ff BYTHE POLICIES
<br />gtD(�ERD�
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONfffT,gF�Tyy pl pyrt
<br />rLULL.U�(UZAUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. /'11.0 V Cll V ate
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADr ITIONAL 1 J@t�i� groiNWbr 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 LICENSE NO. 0637431
<br />CONTACT NAME: pgTRICK MCRAE
<br />PHONE (714) 779-6999 uc Net (714) 779-6903
<br />PATRICK MCRAE INSURANCE SERVICES
<br />1265 N. MANASSERO ST. SUITE 303
<br />E-MAIL
<br />SS: certrequest@mcraeinsurance.insure
<br />INSURERS AFFORDING COVERAGE
<br />NAIL#
<br />ANAHEIM HILLS, CA 92807
<br />INSURERA: NAVIGATORS SPECIALTY INSURANCE CO.
<br />36056
<br />INSURED
<br />INSURERS: INSURANCE COMPANY OF THE WEST
<br />27847
<br />INSURERC: INTEGON NATIONAL INSURANCE COMPAN
<br />29742
<br />CROSSTOWN ELECTRICAL & DATA, INC.
<br />INSURERD: ATLANTIC SPECIALTY INSURANCE COMPA
<br />27154
<br />5454 DIAZ STREET
<br />IRWINDALE CA 91706
<br />INSURERE: GREAT AMERICAN INSURANCE CO.
<br />16691
<br />1 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />AODL
<br />SUBR
<br />POLICYNUMSER
<br />MMIODY�
<br />MM/DD EXP
<br />LIMIT
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FXI OCCUR
<br />XCU
<br />X
<br />X
<br />LA21CGLZ04TP71C.
<br />DEDUCTIBLE $5,000 PER
<br />OCCURENCE
<br />09/03/202109/03/2022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 10D,D0D
<br />X
<br />VIED EXP (Any one person)
<br />$ 5,000
<br />X
<br />CCP
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY N JECT E LOG
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS -COMPIOPAGO
<br />$ 2,000,000
<br />IEBL
<br />$ 1,000,000
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />X
<br />X
<br />2005675448
<br />COMP: $1,000
<br />11/051202111/0512022
<br />OMaBIINdEeDtSINGLE LIMIT
<br />$ 1,000,000
<br />J(
<br />BODILY INJURY (Per person)
<br />$ _
<br />AUTOSOWNED SCHE ULED
<br />AUTOS ONLY M
<br />NON -OWNED
<br />ONLY AUTOS ONLY
<br />COLL: $1,000
<br />BODILY INJURY(Per accident)HIRED
<br />XAUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$ -
<br />E
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />TUE257205203
<br />06/03/202109/03/2022
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />X
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />UNDERLYING LIMITS:
<br />GL; AL; EL POLICIES
<br />AGGREGATE
<br />$ 10,000,000
<br />X
<br />DED I I RETENTION$ 0
<br />_
<br />$ -
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />A CERIM M ERE%CLUDE09ECUTIVE Y�
<br />(Mandatory In NH)
<br />NIA
<br />x
<br />WVE 5030354-07
<br />06103/202206/03/2023
<br />X I STATUTE I ERH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />Use. describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />D
<br />f
<br />PROPERTY &
<br />CONTRACTORS
<br />710039414
<br />$1,000 DEDUCTIBLE
<br />COV. INCL. THEFT
<br />05/10/2022
<br />5/10/202
<br />��eeL. ° rep
<br />EQUIPMENT
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />THE CITY OF SANTA ANA IS NAMED AS ADDITIONAL INSURED WITH RESPECTS TO THE ABOVE MENTIONED POLICIES PER ATTACHED
<br />ENDORSEMENT(S). COVERAGE IS PRIMARY & NONCONTRIBUTORY AS REQUIRED BY WRITTEN CONTRACT, PER ATTACHED ENDORSEMENT
<br />FORMS. WAIVER OF SUBROGATION APPLIES, IF REQUIRED BY
<br />WRITTEN CONTRACT.
<br />' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, A 30 DAY WRITTEN NOTICE WILL
<br />BE ISSUED.
<br />RE: ATMS AND COMMUNICATION SYSTEMS, ON CALL REPAIR SERVICES, JOB #4775-22
<br />TION
<br />CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 CIVIC CENTER PLAZA M-30 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />SANTA ANA, CA. 92702 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />Z".? _ _ RiekMarugrnuntDfuu[an
<br />«'i#..►► REmEXED&APPROVEDBY:
<br />©1988-2015 ACORD ( f( ? A-a.p "44
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Rhk Management specialist
<br />
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