|
A�ORO
<br />KIMCSTA-01
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />7/30/2024
<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 License # OM70471 CONT_NAMEACT Jo) Lay I
<br />Orion Risk Management InsuranAnqie
<br />es, An Alera Group4hsurance PHONE
<br />Agency, LLC (A/C, No, Ext): / o)
<br />1800 Quail Street, Suite 110 E-MAIL DDDRS,!jiay ~< I firZU6Mi—
<br />Newportort Beach, CA 92660
<br />IN URER S AFFARDING COVEIi4GE A NAIC
<br />PF INSURERA : PH', \D D nf"ecmeevon
<br />INSURED INSURER13:X.In'ura aAmerica. 24554
<br />Kimco Staffing Services, Inc. INSURERC: .scot cial Ins
<br />17872 Cowan Ave INS ERr --uai-e
<br />Irvine, CA 92614 n �� �� ` AV ��
<br />COVERAGES
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOI / Ht ✓E BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIvry 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 />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />PHPK2599195
<br />9/1/2023
<br />9/1/2024
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />100,000
<br />$
<br />MED EXP (Any oneperson)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />X
<br />PRO LOC
<br />POLICY JE
<br />PRODUCTS - COMP/OP AGG
<br />$ 3,000,000
<br />SEXUAL PHYSICAL
<br />$ 1,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />CMBINED SINGLE LIMIT
<br />EaOaccident
<br />1,000,000
<br />$
<br />X
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />X
<br />X
<br />PHPK2599195
<br />9/1/2023
<br />9/1/2024
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY DAMAGE
<br />Per accident)
<br />ccident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />PHUB880493
<br />9/1/2023
<br />9/1/2024
<br />AGGREGATE
<br />$ 5,000,000
<br />DED X RETENTION $ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/ R/EXECUTIVE
<br />EXCLU
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />X
<br />RW D300121607
<br />12/31 /2023
<br />12/31 /2024
<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 />C
<br />Employment Practice
<br />MLPC241000131902
<br />7/1/2024
<br />7/1/2025
<br />Each Claim/Aggregate
<br />2,000,000
<br />A
<br />Professional Liability
<br />PHPK2599195
<br />9/1/2023
<br />9/1/2024
<br />Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or
<br />memorandum of understanding.
<br />Such insurance as is afforded by this policy shall be primary, and any insurance carried by City shall be excess and noncontributory.
<br />Waiver of Subrogation applies to the Workers Compensation, Auto Liability, and General Liability endorsements.
<br />30 Days' Notice of Cancellation with 10 Days' Notice of Non -Payment of Premium in accordance with the policy provisions
<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 PRG
<br />Risk Management Division ;"orz,"�E RAManagmumtDMs(an
<br />20 Civic Center Plaza i REVIEWED
<br />Santa BY.
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE A ' t`avdo
<br />e—mm,� Risk Management Specialist
<br />ACORD 25 (2016/03) © 1988-2015 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />
|