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HOWRGEN-01 DORTIZ
<br />,d►coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br />�/ 6/20/2024
<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 NAME • • •
<br />:
<br />MG Skinner & Associates • PHONE 31 47 Axcrr
<br />11030 Santa Monica Blvd., SAncue
<br />(A/C, No, Ext): ( ) (A/ , ( )
<br />Los Angeles, CA 90025 141
<br />E-MAIL DD SS:
<br />SUR S O • RA
<br />INSURED
<br />AppleOne, Inc. dba
<br />fka: Howroyd Wrig
<br />P.O. Box 29048
<br />Glendale, CA 912
<br />IeOne Employment Services
<br />Iployment Agency, Inc.
<br />INSURERA:Tokl In S
<br />INSURERB:Acr Amy sican Ins
<br />MISURER C : ,ca` — �
<br />22667
<br />1
<br />CnVFRAnPA CERTIFICATE NI IMRFR• l / a ) _ alrV0CInIR'Im LMRF1F l / I V It
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW 1- A"-: 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />PPK2679926
<br />4/1/2024
<br />4/1/2025
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />100 000
<br />$
<br />X
<br />MED EXP (Any oneperson)
<br />$ 5,000
<br />Contractual Liab.
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />X
<br />POLICY JECT � LOC
<br />PRODUCTS -COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />X
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />PPK2679926
<br />4/1/2024
<br />4/1/2025
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />ccident
<br />Per accident)
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />PUB909174
<br />4/1/2024
<br />4/1/2025
<br />AGGREGATE
<br />$ 10,000,000
<br />DED X RETENTION $ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y/N
<br />ANY PROPRIETOR/ R/EXECUTIVE
<br />OFFICER/MEMBER EXCLU EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />WLRC55650640
<br />4/1/2024
<br />4/1/2025
<br />X PER OTH-
<br />STATUTE ER
<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 />A
<br />Crime (3rd Party)
<br />PPK2679926
<br />4/1/2024
<br />4/1/2025
<br />Occurrence/Aggregate
<br />3,000,000
<br />A
<br />E&O/Prof. Liab.
<br />PPK2679926
<br />4/1/2024
<br />4/1/2025
<br />Each Claim/Aggregate
<br />3,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Job ID 009500724003
<br />"Re: City of Santa Ana Agreement No. A-2018-146". The City of Santa Ana, officers, agents, employes and volunteers are named additional insured on this
<br />policy pursuant to written contract, agreement, or memorandum of understanding. Primary and Non -Contributory coverage will apply. Waiver of Subrogation
<br />i s covered under General Liabilty for clerical positions only. Notice of Cancellation under applicable policies: 30 days/ 10 days for non-payment of premium.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREO
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PR(
<br />Attn: Breanna Lynch ;"orz,"�E RAManagmumtDivis(an
<br />20 Civic Center Plaza � REvIEWED&APPRO
<br />Santa Ana, CA 92701-4010 AUTHORIZED REPRESENTATIVE �nq
<br />° 1_If•a, _I_�Y L% t 1 t`f�yVEDBY.
<br />LZVe
<br />Risk Management Specialist
<br />ACORD 25 (2016/03) © 1988-2015 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />
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