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Francine R. Digitally signed by Francine <br />R. R. Villa reaI <br />Villareal Date: 2021.11.0911:46:42 <br />-08,00, <br />1 ® <br />A�Ro CERTIFICATE OF LIABILITY INSURANCE <br />DATE(,MMIDDIYYYYI <br />09/2012021. <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. If <br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />ADD Risk Services Northeast,. Inc. <br />New York NY Office <br />CONTACT <br />NAME: <br />INC. No. Eat): C866) 283-7122 ND : C800) 363-0105 <br />E-MAIL <br />ADDRESS: <br />One Liberty Plaza <br />165 Broadway, Suite 3201. <br />New York NY 10006 USA <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURED <br />INSURER A: Hartford Fire Insurance Co. <br />19682 <br />Hanson Bridgett LLP <br />425 Market street <br />INSURER B: Hartford Casualty Insurance CO <br />29424 <br />INSURER C: <br />26th Floor <br />San Francisco CA 941.05 USA <br />INSURER D: <br />INSURER E: <br />NSURER F: <br />ln.111q if 4A�10A gYIIHVL'ILi 9 1-171144 lNIItPA•FIf11rPl¢ i1•lri M LOT 09111 rd-1 P; <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. Limits shown are as requested <br />LTk <br />TYPE OF INSURANCE <br />INSD <br />WVO <br />POLICY NUMBER <br />IMMDDIVYVY <br />MIWDD'YYY <br />LIMITS <br />X <br />COMMERCIALGENERALLIABRUTY <br />CLAIMS-MOE i,X OCCUR <br />UUNDD <br />Commercial Package <br />EACH OCCURRENCE <br />$1,000,000 <br />T <br />PREMISES Eaoccurrencel <br />$300, 000 <br />MED EXP(Any one person) <br />$10,000 <br />PERSONAL &ACV INJURY <br />$1,000,000 <br />GEN'LAGGREGATE LIMITAPPLIES PER: <br />PRO JECT <br />POLICY ❑PRO ❑LOG <br />OTHER: <br />GENERAL AGGREGATE <br />2,000,000 <br />PRODUCTS-COMPADPAGG <br />$1,000,000 <br />A <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />X HIRED AUTOS g NONOWNEDPROPERTY <br />ONLY AUTOS ONLY <br />IODUNDD1980 <br />.commercial Package <br />08/26/202108/26/2022 <br />COMBINED SINGLE LIMIT <br />Fa acamem <br />$1,000,000 <br />BODILY INJURY (Par Person) <br />BODILY INJURY (Par aeciden0 <br />DAMAGE <br />(Par accident) <br />B <br />X <br />UMBRELLALIAB <br />EXCEBS LIAR <br />X <br />OCCUR <br />CLAMS MADE <br />10XHUDH9540 <br />Umbrella <br />08 26 2021108 <br />26 2022 <br />TEACH OCCURRENCE <br />$5,060700 <br />AGGREGATE <br />$5,007000 <br />DEDI <br />RETENTION <br />WORKERS COMPENSATION AND <br />EMPLOYERS'LIABILITY YIN <br />ANY PROPRIETOR I PAWNER I EXECUTIVE ❑ <br />OFFIGERIMEMSER EXCLUDED' <br />(Mandatory in NH) <br />If yyes, describe under <br />DESGB RON OF OPERATIONS below <br />NIA <br />PER STATUTEOTH- <br />'DER <br />E.L. EACH ACCIDENT <br />E.L. DISEASEEAEMPLOYEE <br />E.L. DISEASEPOLICYLIMIT <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached IT more space is required) <br />`v <br />0 <br />Z <br />N <br />U <br />L) <br />CERTIFICATE HOLDER CANCELLATION 0 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />POLICY PROVISIONS. <br />City of Santa Ana AUTHORIZED REPRESENTATIVE <br />20 civic Center Plaza (M-30) <br />P.D. BOX 19CA e� lK <br />Santa Ana, CA 92702-I988 USA <br />,,,, a Twat lvuaatgemer¢umalort <br />t <br />01988-2015 ACORD CO fiEV""y"D is APPRCNEG Sr' <br />'' I. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD �I a c'c' <br />Risk Management Analyst <br />