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V11 F I1=1 alll I Date:2022.05.0310:47:40-07'OU
<br />AC 0® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM DD VYYV)
<br />04/28/2022
<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 pollcy(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 />CONTACT Nancy Stoltlemyer
<br />NAME:
<br />Insurance Brokers of MD - Hagerstown
<br />PHONE (301) 790-0652 PAX (301) 790-0962
<br />A/C No Ext: AIC No:
<br />13126 Pennsylvania Ave.
<br />nooaesE. nancy.stottlemyerr@lbmofmd.com
<br />PO Box 3767
<br />INSURER($) AFFORDING COVERAGE
<br />NAIL#
<br />INSURER A: Twin City Fire Ins. Co.
<br />29459
<br />Hagerstown MD 21742
<br />INSURED
<br />INSURER B: Hartford A8,1 Co.
<br />22357
<br />The Library Corporation
<br />INSURER C: Hartford Casualty Ins. Co.
<br />29424
<br />Carl Corporation and Tech -Logic Corporation
<br />INSURER D: Hartford Fire Ins. Co.
<br />19882
<br />1 Research Park
<br />INSURER E:
<br />Inwood WV 25426
<br />1 INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 2022-2023 REVISION NUMBER:
<br />THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR R
<br />TYPE OF INSURANCE
<br />INSD
<br />WVO
<br />POLICY NUMBER
<br />MMIDO/YYYY
<br />MMIDDIYYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE X OCCUR
<br />EACHOCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TRENTED
<br />O
<br />PREMISES Ea occurrence
<br />$ 1,000,000
<br />MED EXP(Any one arson)
<br />$ 10,000
<br />PERSONALaADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />30SBAVK5698
<br />05108/2022
<br />0510812023
<br />GEWLAGGREGATE LIMITAPPLIES PER:
<br />PRO � LOC
<br />POLICY � ECT
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMPIOPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINEDSINGLE LIMIT
<br />Ea accldent
<br />$ 1,OOQ000
<br />X
<br />BODILY INJU RY(Per person)
<br />$
<br />ANYAUTO
<br />B
<br />OWNED SCHEDULED
<br />AUTOS ON LV AUTOS
<br />3OUECFP3134
<br />05/08/2022
<br />05/00/2023
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />$
<br />X
<br />UMBRELLA LIAB
<br />v
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 6,000,000
<br />AGGREGATE
<br />$ 6,000,000
<br />A
<br />LIAB
<br />CLAIM&MADE
<br />30SBAVK5698
<br />05/08/2022
<br />05/08/2023
<br />IEXCEBS
<br />DED X1 RETENTION $ 10,000
<br />$
<br />Q
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY y/N
<br />CUTIVE
<br />ANY PROPRIETOREXCL EXCLUDED?
<br />EM BER EXCLUOE09
<br />(MandaOFFICtory NH)
<br />IMes,
<br />NIA
<br />30WECAD2KBN
<br />05/08/2022
<br />05/08/2023
<br />X SPER TATUTE ERH
<br />E.L. EACH ACCIDENT
<br />1,000,ODO
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />describ
<br />If DESCRIPTION
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />D
<br />E&O, Information Risk, Media Liability &
<br />First Party Expense -Claims Made
<br />30TE0336969-22
<br />05108/2022
<br />05/08/2023
<br />Policy Aggregate
<br />Wrongful Act
<br />Each Wron 9
<br />$5,000,000
<br />$5,000,000
<br />Retention
<br />$ 25,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required)
<br />City of Santa Ana, It's Officers, employees, agents, volunteers and representatives are additional insured as indicated, and coverage is primary,
<br />non-contributory when required by written contract. Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation.
<br />City Of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza 4th FI
<br />Santa Ana
<br />ACORD 25 (2016/03)
<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 />AUTHORIZED REPRESENTATIVE
<br />CA 92702 ' F4 1
<br />RENEWED 6APPaovm lM
<br />01988-2015 ACORD COI a
<br />The ACORD name and logo are registered marks of ACORD 7mw Pww"
<br />R61<ManaDenxnr CledwlArtle
<br />
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