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A-2021-110-02A
<br />Tori Piersorpatee202]06�,5:2036e o7 pp
<br />A CERTIFICATE OF LIABILITY INSURANCE
<br />DaT6(MMD°"""'
<br />5/26/2022
<br />THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ON WAND 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. H the certificate holder Is an ADDITIONAL INSURED, the PORGY(les) must be endorsed. If SUBROGATION ISWAIVED, sub)ectto
<br />the terms and conditions of the policy, certain pollclas may require an endorsement. A statement on this certificate does not confer rights to the
<br />cerdflcate holder In lieu of such endweement(s).
<br />PRODUCER
<br />ONTAUT
<br />AMM
<br />HONE f661)266-9390 Nal (6611366-8391
<br />Driscoll S Driscoll Ineurenee Agency, Ino.4l23
<br />a-MAIL Certa9DrieaollandDriaeoll.eom
<br />Aoo ass:
<br />St Weat, Suite 8
<br />INSURERS AFFORDIN OOVERAOE
<br />HAM $
<br />Palmle
<br />Palmda
<br />dale CA 93551
<br />INSURER A, Nautilus Insurance Company
<br />INWRED
<br />INSURERSiKeY Risk Insurance Company
<br />IN0URERC:1n9UranCe COMPBUDY Of the West
<br />Chambers Group, Ina
<br />INSURER DI
<br />5 Hutton Cantor Drive, Suits 750
<br />mauaeR e: "
<br />Banta Ana CA 92707
<br />INOURERPI
<br />PMICaeAf]CR ne,vw„e,nw�-r• uue,nn�...�nnvnn., nnnn
<br />��._ __._ ____ __.
<br />THIS IS TO CERTIFYTHAT 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 ANYCONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED SYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSICNSANO CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />L R
<br />TYPE OF INSURANCE
<br />APUL man
<br />WVD°R
<br />POLICVN B¢
<br />POLICY EN
<br />PpuCYE%P
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />EACH OCCURRENCE
<br />E 1,000, OLIO
<br />E -NTE'j�[ p
<br />PREMISES c m
<br />E 100,000
<br />„
<br />MED EYP (Any one person
<br />X
<br />Y
<br />ECP20263OS-11
<br />6/1/2022
<br />5/12/2023
<br />$ 10,000
<br />PERSONAL &AM INJURY
<br />$ 1,000,ODO
<br />OEM AGGREGATE LIMIT APPLIES PER;
<br />X POLICY ❑ JEC ❑ LOC
<br />OENERALAOGREOATE
<br />E 2,000, OLIO
<br />PRODUCTS. COMPIOPAGG
<br />$ 2,000,000
<br />OTHER:
<br />- - '
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />..(as
<br />WMBINEDS11,181,ELIM
<br />sork.1111
<br />1,000,ODO
<br />B'
<br />X
<br />AWAUTO
<br />VTOWNED �HOSULEp
<br />HIREDAUTOS NO"L NED
<br />AUTOS
<br />m1P203Y030-10
<br />6/1/2022
<br />5/12/2023
<br />BODILY INJURY (Per mason)
<br />$
<br />BODILY INJURY (Per aaaM8n0
<br />$
<br />PROPERTY OE
<br />fear -add-011E
<br />$
<br />,A
<br />..X
<br />,UMQRELLALIA9-
<br />Pe%DEe$LMB. ..
<br />X
<br />..
<br />OCCUR-
<br />OLAIMS41ADE
<br />-
<br />..
<br />- .. ...
<br />... ..... � -
<br />.. .....
<br />.
<br />--
<br />EACH OCCURRENCE
<br />$ l0 000 0 0
<br />AGGREGATE .. ..
<br />s 10,000,000
<br />DED,. .. 7E N-E. .. .. _..
<br />$
<br />PPX2026322-L4
<br />6/l/2022
<br />5/12/2023
<br />C'
<br />WORKERS COMPENOATI N
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIE%ECURVE
<br />OFFMERIMEMBEREXCLUDEDY ❑Y
<br />(Mandatory to NH)
<br />UESCR
<br />NIA
<br />'
<br />WVR 8069233 02
<br />5/12/2022
<br />5/12/2023
<br />XspTarum .E7
<br />El, EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE-EAEMPLOYEE
<br />$ 1 000 000
<br />E.L. DISEASE• POLICY LIMIT
<br />$ 1 C00 000
<br />PanIIO 4 OFd9YE TONS below
<br />A
<br />C-UY Pollution Liability
<br />RCP2026303-14
<br />6/1/2022
<br />5/12/2023
<br />Pw OWIA00 1 M / 2 M
<br />A
<br />Professional. Liability
<br />ECP2026303-14
<br />6/1/2022
<br />6/12/2023
<br />Prime Made 11000,000
<br />DRSORIPTIONDP OPERATIONS ILOCAnONO) VEHICLEB (ACORD 101, MdiftI sal Remarks Sehadule, maybe aUeched If mom $Pam I6 required)
<br />Blanket Waiver applies to the General Liability Policy per form S MCP 1260 01 21, Blanket Primary &
<br />Non-Oontributory wording applies to the General Liability Policy par form 5 BCP 1246 Ol 21. Blanket
<br />Additional Insured applies to the General Liability Policy per form N ECP 1246 01 21 4 RCP 1248. 01 21, in
<br />tivac. of4' City'bf'89nta Ana, officers, agents, employees, and volunteers. 10 day Notice of Cancellation
<br />for. Non=paymant_i 30 day for all other,
<br />CERTIFICATE HOMER CANCELLATION
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />ACORD 25 (2014101)
<br />INS025 (201401)
<br />SHOULD ANY OF THE ABOVE OESCRIBEO POLIO -
<br />THEEXPIRATIONDATETHEREOF, NOTICE WILL MaW6ellentDIM *A
<br />ACCORDANCE WITH THE POLICY PROVISIONS, i1Mr4A4EUG'E$aV'W.6ki
<br />aia9'G
<br />AUTHORIZED REPRESENTATNSR6kAMlkgen6vrc{Itl7mlAlde
<br />ROSE Dri Scoll, Sr/DM
<br />01986-2014 ACI
<br />The ACORD name and logo are registered marks of ACORD
<br />
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