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CERTIFICATE OF LIABILITY INSURANCE DATE(M07/03//2024 Y)
<br />024
<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 CONTACT (wrl n
<br />NAME: • v s•
<br />CSIS Insurance Services PHONE (8 ) 5 1 881
<br />A/C No Ex
<br />E-MAIL k; irl CSISOn I m
<br />Angi
<br />ADDRESS:
<br />3315 Old Conejo Road NSURER(S)AFFpRDING C RAGE NAIC #
<br />Thousand Oaks e91320 INSURER A: iart rI r nfAf p 30104
<br />INSURED INSURER P F, ord CI a n l m tv o a 22357
<br />3di Inc
<br />3 Pointe Dr.
<br />Brea
<br />COVERAGES
<br />INSURER , : Hai 'rd Casualty I
<br />INSURr . D
<br />-uatj
<br />I ER F:
<br />1 I IN' NER F:
<br />MBE1l!I. s/z11111111111l 1 /1 •
<br />29424
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE',EE' ISSUED TO THE IN URE R D BORNE E POL ERIO
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OI ° Y 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />1,000,000
<br />$
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />Y
<br />72SBABC9000
<br />08/03/2024
<br />08/03/2025
<br />LAGGREGATE LIMITAPPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY❑PECT ❑LOC
<br />MOTHER
<br />PRODUCTS-COMP/OPAGG
<br />$ 2,000,000
<br />Designated Person
<br />$
<br />:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />B
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Y
<br />Y
<br />72UECZD5366
<br />08/03/2024
<br />08/03/2025
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />Underinsured motorist
<br />$ 1,000,000
<br />X
<br />UMBRELLA LIAB
<br />OCCUR
<br />�" _RURREN"'�"C
<br />EACH
<br />GT6" CCOE
<br />4,000,000
<br />$
<br />HCLAIMS-MADE
<br />AGGREGATE
<br />$ 4,000,000
<br />A
<br />EXCESS LIAB
<br />Y
<br />Y
<br />72SBABC9000
<br />08/03/2024
<br />08/03/2025
<br />DED I X1 RETENTION $ 10,000
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />Y
<br />72WECAM7FEE
<br />08/03/2024
<br />08/03/2025
<br />PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />1,000,000
<br />$
<br />A
<br />72SBABC9000
<br />08/03/2024
<br />08/03/2025
<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, its officers, officials, employees, and volunteers are added as additional insured as required by written contract in respects to
<br />General Liability and Auto Liability, per attached. The General Liability policy evidenced herein is Primary & Non -Contributory where required by written
<br />contract with the named insured. A Waiver of Subrogation is granted in favor of the additional insured with respects to General Liability, Auto Liability and
<br />Workers' Compensation in accordance with the policy's provisions, per attached. Umbrella coverage extends over the Business Owners Policy,
<br />Commercial Auto and Workers' Compensation, as per policy provisions, and as provided by The Hartford. NOTE: If a signed written contract is NOT in
<br />place, then coverage under the Additional Insured/Primary & Non-Contributory/Waiver of Subrogation does NOT apply and is voided.
<br />'PLEASE SEE PAGE TWO FOR ADDITIONAL COVERAGE'
<br />CERTIFICATE HOLDER CANCELLATION
<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 Community Development Agency ACCORDANCE WITH THE POLICY PRO\
<br />_ Risk ManagementDiviaian
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE REVIEWED & APPROVED BY.
<br />o � w
<br />Santa Ana CA 92702 ®' Risk Management Specialist
<br />© 1988-2015 AC
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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