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,acoR®� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIOoMYY)
<br />`.../
<br />11/28/2022
<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
<br />CONTACT Tina Cowie
<br />NAME:
<br />Cornerstone Specialty Insurance Services, Inc.
<br />HONEo (714) 731-7700 FAX (714) 731 -7750
<br />IPA Ent: A/C, No:
<br />14252 Culver Drive, A299
<br />ADDRESS: tlna@cornerstonespecialty.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC9
<br />Irvine CA 92604
<br />INSURERA: RLI Insurance Company
<br />13056
<br />INSURED
<br />INSURER B: Aspen American Insurance Company
<br />43460
<br />BOAARCHITECTURE
<br />INSURER C:
<br />1511 Cote Avenue
<br />INSURER D:
<br />INSURER E
<br />Long Beach CA 90813
<br />INSURERF:
<br />CERTIFICATE NUMBER: 2z/z3
<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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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 />ILTR
<br />TYPE OF INSURANCE
<br />0
<br />o
<br />POLICY NUMBER
<br />FF
<br />MM/DUP/YYY
<br />POLICY EXP
<br />MMIDDNYYY)
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I —XI OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />PREMISES Eaoccurrence
<br />$ 1,000,000
<br />x
<br />MED EXP(Any one person)
<br />$ 10,000
<br />ADDT'L INSURED /P&NC
<br />X1
<br />BLNKTWVROFSUBRO
<br />PERSONAL&ADV INJURY
<br />$ INCLUDED
<br />A
<br />Y
<br />Y
<br />PSB0007999
<br />11/20/2022
<br />11/2012023
<br />GEN'LAGGREGATELIMITAPPLIES PER:
<br />POLICY [g JECTPRO- ❑ LOC
<br />GENERALAGGREGATE
<br />$ 4,000,000
<br />PRODUCTS - COMP/OPAGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 2,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED v NON -OWNED
<br />AUTOS ONLY ^ AUTOS ONLY
<br />Y
<br />Y
<br />PSB0007999
<br />11/20/2022
<br />11/2012023
<br />X
<br />BGDILV INJURY(Per acdtlent)
<br />$
<br />PROPERTY DAMAGE
<br />Per accitlenl
<br />$
<br />X1
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />Y
<br />Y
<br />PSE0003983
<br />11/2012022
<br />11/20/2023
<br />OED T RETENTION $
<br />It
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICEWMEMBER EXCLUDED? ❑Y
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />Y
<br />PSW0004454
<br />11/2012022
<br />11/2012023
<br />v
<br />/� STATUTE ERH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 11000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />B
<br />Professional Llablllty
<br />Claims Made
<br />AAAE100264-04
<br />11/20/2022
<br />11/20/2023
<br />EACH CLAIM
<br />ANNUALAGGREGATE
<br />$2,000,000
<br />$2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required)
<br />The City of Santa Ana, Its officers, officials, employees, and volunteers are Additional Insured for General Llablllty & Non -owned and Hired Auto Liability, on
<br />primaryfnon-contributory basis, but only if required by written contract with the Named Insured prior to an occurrence and as per attached endorsement.
<br />Coverage is subject to all policy terms and conditions. 30 days Notice of Cancellation *Except 10 days Notice of Cancellation for non-payment of premium.
<br />For Professional Liability coverage, the aggregate limit Is the total insurance available for all covered claims reported within the policy period.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE n
<br />Santa Ana CA 92702 . //._
<br />@ 1988.2015 ACORD CORPORATION. All rinhte
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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