|
AC"MO`er CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br />09/29/2023
<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 lie i of such endorsement(s).
<br />PRODUCER I
<br />Mi tone Risk ManagERnent & Ins ur a Services HONE E (94 52-0909 a/c, No : (949) 852-1131
<br />A,orerrtoeigtile
<br />Acevedo @6^� ®auffman@milestonepromise.com
<br />I U R FO DI V A NAIC #
<br />Irvine CA s2606 D NE p t ns r p f i slloo' 019046
<br />INSURED INSURER B: Travelers Property Casualty Company of America 256740
<br />C3 Office Solutions LLC, DBA: C3 Technology Services INSURER C : Lloyd's of London
<br />1536 E. Warner Ave. INSURER D :
<br />INSURER E :
<br />Santa Ana CA 92705 INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 23/24 MASTER 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 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 INSURANCEAUULbUBK
<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 />$ 2,000,000
<br />CLAIMS -MADE FX OCCUR
<br />PREM SDA AGES Ea oNcurDrence
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 2,000,000
<br />A
<br />Y
<br />680-6N797658
<br />05/23/2023
<br />05/23/2024
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />X POLICY ❑ PRO ❑ LOC
<br />JECT
<br />PRODUCTS-COMP/OP AGG
<br />$ 4'000'000
<br />$
<br />OTHER:
<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 />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BA-6N798090
<br />05/23/2023
<br />05/23/2024
<br />BODILY INJURY (Pe r accide nt)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />B
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />CUP-7N447797
<br />05/23/2023
<br />05/23/2024
<br />DED I X1 RETENTION $ 0
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABI LI TY Y/N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N /A
<br />UB-2R956754
<br />10/02/2023
<br />10/02/2024
<br />X STATUTE EORH
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<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 />Each Claim
<br />$2,000,000
<br />C
<br />Professional Liability/ E&O
<br />ESL0039566654
<br />11/19/2022
<br />05/23/2024
<br />Aggregate
<br />$2,000,000
<br />Retention
<br />$10,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as additional insureds with respects to GL per the attached
<br />endorsement. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City of Santa Ana shall be excess and
<br />noncontributory per attached endorsement. A waiver of subrogation is in favor or the certificate holder, with respects to the GL, where required by written
<br />contract, per the attached endorsement form. *30 days written notice of cancellation to the certificate holder/10 days notice for nonpayment of premium.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Flr
<br />Santa Ana
<br />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 PROIFZ
<br />AUTHORIZED REPRESENTATIVE
<br />oR,N a Risk ManagmumtDMsIan
<br />f REVIEWED & APPROVED BY.
<br />1" Risk Management Specialist
<br />@ 1988-2015
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|