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ACC)R6r CERTIFICATE OF LIABILITY INSURANCE
<br />lil.--/
<br />DATE(MMIDD/YYYY)
<br />1014/2022
<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 />RBN Insurance Services
<br />303 E Wacker Dr Ste 650
<br />Chicago IL 60601
<br />CONTACT
<br />NAME: S mone White
<br />PHONE 312-856-9400 FAX
<br />H INC.No): 312-856-9425
<br />id.
<br />ADORIL
<br />ES swhite rilnlnsurance,com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Hartford Flre Insurance Co.
<br />19682
<br />INSURED SAFELL"l
<br />Consulting Group
<br />P.O. Box
<br />P.O. 18330
<br />INSURER B: Hartford Casualty Insurance Cc
<br />29424
<br />INSURERC: Great American E&S Ins. Co.
<br />37632
<br />INSURERD: Bridgeway Insurance Company
<br />12489
<br />Boulder CO 80308
<br />INSURER E: TWIN CITY FIRE INS CO CO
<br />29459
<br />INSURER F: Lexin on Insurance Company
<br />19437
<br />COVERAGES CERTIFICATE NUMBER-821MR101 RFVIAIf1M NIIMRFR-
<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.
<br />ILNSR
<br />TR
<br />TYPE OF INSURANCE
<br />AOOL
<br />INSD
<br />SUBR
<br />MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />M DDMYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIALGENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />Y
<br />Y
<br />83UENZV3951
<br />10/312022
<br />10/3/2023
<br />EACH OCCURRENCE
<br />$1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES En occurrence
<br />$1,000,000
<br />MED EXP(Any one person)
<br />$10,000
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY JEST LOC
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GEN'L
<br />PRODUCTS - COMP/OP AGE
<br />$2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />83UENPY9100
<br />10/3/2022
<br />10/3/2023
<br />COMBINED SINGLE LIMIT
<br />Ea axident
<br />$11000,000
<br />X
<br />ANYAUTO
<br />BODILY INJURY (Per person)
<br />$
<br />IAUTOS
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />HIRED X NON -OWNED
<br />ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />Excess Auto Llab.•
<br />$1,000,000
<br />D
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />BE-A7-XL-0002079-01
<br />10/3/2022
<br />10/3/2023
<br />EACH OCCURRENCE
<br />$5,000,000
<br />AGGREGATE
<br />$5,000,000
<br />X
<br />EXCESSLIAB
<br />CLAIMS -MADE
<br />DED X RETENTIONn
<br />$
<br />E
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETOWPARTNERIEXECUTIVE N
<br />OFFICER/MEMBEREXCLUDED4
<br />NIA
<br />Y
<br />83WECE0623
<br />5/12/2022
<br />5/12/2023
<br />X I STATUTE �RH
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory In NH)
<br />nder
<br />yes, under
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />D
<br />DESCRIPTION OPERATIONS below
<br />C
<br />F
<br />Professional Liability
<br />Excess Ties(2nd) Layer
<br />TER 2861558
<br />011170891
<br />10/3/2022
<br />10/3/2022
<br />10/3/2023
<br />1013/2023
<br />Each ClaindAggregate
<br />Each OWAggregale
<br />10,000,000
<br />6,000,000
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />"Excess Auto Liability Buffer Policy:
<br />Endurance American Specialty
<br />EXT30025875000
<br />101312022-2023
<br />The City of Santa Ana, its officers, employees, agents and representatives are Additional Insured on a primary and non-contributory basis as respects the
<br />General Liability and Auto Liability as required by written contract. A Waiver Of Subrogation applies in favor of the Additional Insured as respects General
<br />LiabilityAuto Liability, and Workers Compensation as required by written contract. 30 Days notice of cancellation applies. 10 days notice of cancellation for
<br />non-payment of premium applies.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AEU-T-HHO'R�IZED REPRESENTATIVE
<br />©1988-2015 ACORD
<br />reserved.
<br />ACORD 25 (2016103)
<br />The ACORD name and logo are registered marks of ACORD
<br />
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