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BIGBENC-01
<br />EHENG
<br />lib i CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 12/22/202Y"'
<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(les) 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 License # OM70471
<br />Orion Risk Management Insurance Services, An Alera Group Insurance
<br />Agency, LLC
<br />1800 Quail Street, Suite 110
<br />Newport Beach, CA 92660
<br />COME:NTACT
<br />A
<br />ucoNly , E:l : 949 263-6850 FnAic , No :949) 263-6860
<br />n-
<br />INSURERS AFFORDING COVERAGE
<br />NAICk
<br />INSURERA: Starr Surplus Lines Ins. Co.
<br />13604
<br />INSURED
<br />INSURER B.Depositors Insurance Company
<br />42587
<br />INSURERC: NATIONWIDE MUTUAL INSURANCE COMPANY
<br />23787
<br />Big Ben, Inc.
<br />INSURER D:
<br />4790 Irvine Blvd. #105-404
<br />Irvine, CA 92620
<br />INSURER E
<br />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 CONTRACTOR 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 LTRTYPE
<br />OF INSURANCE
<br />ADDLSUBRINSD
<br />We
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />1000066896221
<br />41512022
<br />4/512023
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES(Ea c i
<br />100,000
<br />GENE
<br />MEDEXP An one emon
<br />$ 5,000
<br />PERSONAL S ADV INJURY
<br />$ 2,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY ®5ECOT LOC
<br />OTHER,
<br />GENERAL AGGREGATE
<br />$ 1,000,000
<br />PRODUCTS-COMP/OPAGG
<br />$ 2,000,000
<br />B
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS ED
<br />AUTOS ONLY AUTOW ONNLY
<br />X
<br />X
<br />ACPBA3100135937
<br />7/112022
<br />7/1/2023
<br />COMBINNESINGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJU RY Per pars.nn
<br />$
<br />BODILY INJURY Per accident
<br />$
<br />PeOecclCenl AMAGE
<br />$
<br />A
<br />X
<br />UMBRELLA LIPS
<br />EXCESS LIAR
<br />OCCUR
<br />CLAIMS -MADE
<br />1000337275221
<br />4/5/2022
<br />415/2023
<br />EACH OCCURRENCE
<br />$ 9,000,000
<br />M
<br />AGGREGATE
<br />$ 9,000,000
<br />DED RETENTION$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETCRIPARTNERIEXECUTIVE YIN
<br />OFFICEWMEMBEq EXCLUDED? �Y
<br />(Mandatory In NHl
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />X
<br />pCPWC311035937
<br />7/1/2022
<br />71112023
<br />X I PER OTH-
<br />E ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />11000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES ACORD led, Additional Remadcs Schedule, ma be attached if more space is requlred)
<br />City of Santa Ana, its officers, employees, agen sand representatives are Additlonalylnsureds with respect is named as additional insureds with respect to
<br />General and Auto Liablity per the attached endorsements as required by written contract.
<br />Insurance Is Primary and Non -Contributory.
<br />Waiver of Subrogation applies per the terms of the attached Automobile Liability and Workers' Compensation endorsements and General Liability
<br />endorsement.
<br />SEE ATTACHED ACORD 101
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cityof Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Risk Management Division
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, 4th Floor
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701
<br />s
<br />ACORD 25 (2016/03) ©1988.2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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