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GLADGOV-01 SGONZALEZ
<br /> ,d►coRo CERTIFICATE OF LIABILITY INSURANCE F
<br /> DATE(MM/DD/YYYY)
<br /> 11/1/2024
<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#0757776 CONTACT Jordan Bartleson
<br /> NAME:
<br /> HUB International Insurance Services Inc. PHONE ) FAX
<br /> PO Box 5345 (A/C,No,Ext):(951 779-8575 No):(951)231-2565
<br /> Riverside,CA 92517 E-MAIL Jordan.Bartleson@hubinternational.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA:Hartford Underwriters Insurance Company 30104
<br /> INSURED INSURERB:Hartford Accident and Indemnity Company 22357
<br /> Gladwell Governmental Services,Inc. INSURERC:Hartford Casualty Insurance Company 29424
<br /> P.O. Box 62 INSURER D:United States Liability Insurance 25895
<br /> Lake Arrowhead,CA 92352
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MM/DD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> CLAIMS-MADE Arl
<br /> Aj OCCUR 72SBABF4UK2 10/31/2024 10/31/2025 DAMAGE TO RENTED 2,000,000
<br /> X PREMISES Ea occurrence $
<br /> MED EXP(Any oneperson) $ 10,000
<br /> PERSONAL&ADV INJURY $ 2,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY� PEA LOC PRODUCTS-COMP/OP AGG $ 4,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO X X 72UECPT0490 10/31/2024 10/31/2025 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident)
<br /> ccident $
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> C WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> Y/N 72WECBK4F2G 10/31/2024 10/31/2025 1,000,000
<br /> ANY PROPRIETOR/EXCLUDED?
<br /> R/EXECUTIVE N/A E.L.EACH ACCIDENT $
<br /> OF EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> D Professional Liab. SP 1020955N 10/31/2024 10/31/2025 [Per Occurrence 1,000,000
<br /> D Professional Liab. SP 1020955N 10/31/2024 10/31/2025 ggregate 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 Additional Insured with regard to General Liability when required by written contract per
<br /> the attached endorsement form SL303610/18.Additional Insured applies with regard to the Auto Liability policy,when required by written contract,per the
<br /> attached endorsement form HA991612/21.
<br /> Should the policies be cancelled before the expiration date,Hub International Insurance Services Inc.(Hub),independent of any rights which may be afforded
<br /> within the policies to the certificate holder named below,will provide to such certificate holder notice of such cancellation within thirty(30)days of the
<br /> cancellation date,except in the event the cancellation is due to non-payment of premium,in which case Hub will provide to such certificate holder notice of
<br /> such cancellation within ten(10)days of the cancellation date.
<br /> CERTIFICATE HOLDER APPROVED CANCELLATION
<br /> By Tu Tran Nguyen at 11:10 am, Feb 07, 2025 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Risk Management Division
<br /> 20 Civic Center Plaza by Tu Tranlly signed
<br /> Tu Tran by Tu Tran
<br /> Santa Ana,CA 92701 Nguyen AUTHORIZED REPRESENTATIVE
<br /> Nguyen°;;?4o�oeoo'
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
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