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<br />DATE (MM/DD/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />08/23/2024
<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 />CONTACT
<br />PRODUCER
<br />WTW Certificate Center
<br />NAME:
<br />Willis Towers Watson Northeast, Inc.
<br />FAX
<br />PHONE
<br />1-888-467-2378
<br />1-877-945-7378
<br />(A/C, No):
<br />(A/C, No, Ext):
<br />c/o 26 Century Blvd
<br />E-MAIL
<br />certificates@wtwco.com
<br />P.O. Box 305191
<br />ADDRESS:
<br />Nashville, TN 372305191 USA
<br />INSURER(S) AFFORDING COVERAGENAIC #
<br />31534
<br />Citizens Insurance Company of America
<br />INSURER A :
<br />Digitally signed by Angie Acevedo
<br />INSURED 36064
<br />The Hanover American Insurance Company
<br />INSURER B :
<br />Wittman Enterprises, LLC
<br />Angie Acevedo
<br />AXIS Insurance Company
<br />37273
<br />INSURER C :
<br />11093 Sun Center Drive Date: 2024.10.07 16:17:15 -07'00'
<br />Endurance American Specialty Insurance Com
<br />Rancho Cordova, CA 9567041718
<br />INSURER D :
<br />INSURER E :
<br />INSURER F :
<br />W34530624
<br />COVERAGESCERTIFICATE 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 />ADDLSUBR
<br />INSRPOLICY EFFPOLICY EXP
<br />TYPE OF INSURANCELIMITS
<br />POLICY NUMBER
<br />LTR(MM/DD/YYYY)(MM/DD/YYYY)
<br />INSDWVD
<br />COMMERCIAL GENERAL LIABILITY
<br />2,000,000
<br />EACH OCCURRENCE$
<br />DAMAGE TO RENTED
<br />1,000,000
<br />CLAIMS-MADEOCCUR$
<br />PREMISES (Ea occurrence)
<br />A10,000
<br />MED EXP (Any one person)$
<br />Y
<br />ZBY-D673317-1008/23/202408/23/2025
<br />2,000,000
<br />PERSONAL & ADV INJURY$
<br />4,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$
<br />PRO-
<br />4,000,000
<br />POLICYLOCPRODUCTS - COMP/OP AGG$
<br />JECT
<br />$
<br />OTHER:
<br />COMBINED SINGLE LIMIT
<br />AUTOMOBILE LIABILITY$1,000,000
<br />(Ea accident)
<br />ANY AUTO
<br />BODILY INJURY (Per person)$
<br />B
<br />OWNEDSCHEDULED
<br />AW6-H950401-0308/23/202408/23/2025
<br />BODILY INJURY (Per accident)$
<br />AUTOS ONLYAUTOS
<br />NON-OWNED
<br />HIREDPROPERTY DAMAGE
<br />$
<br />(Per accident)
<br />AUTOS ONLYAUTOS ONLY
<br />$
<br />UMBRELLA LIAB
<br />4,000,000
<br />EACH OCCURRENCE$
<br />OCCUR
<br />B
<br />UH6-J131275-1008/23/202408/23/2025
<br />EXCESS LIAB
<br />4,000,000
<br />CLAIMS-MADEAGGREGATE$
<br />$
<br />DEDRETENTION$
<br />PEROTH-
<br />WORKERS COMPENSATION
<br />STATUTEER
<br />AND EMPLOYERS' LIABILITY
<br />Y / N
<br />1,000,000
<br />B
<br />ANYP ROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT$
<br />N / A
<br />WH6-D673252-0708/23/202408/23/2025
<br />OFFICER/MEMBER EXCLUDED?
<br />1,000,000
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYEE$
<br />If yes, describe under
<br />1,000,000
<br />E.L. DISEASE - POLICY LIMIT$
<br />DESCRIPTION OF OPERATIONS below
<br />CCrime - Employee Theft/ERISAP-001-001165120-0204/30/202404/30/2025Limit$1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Additional Named Insureds:
<br />Life Line Billing Systems, LLC
<br />SEE ATTACHED
<br />CERTIFICATE HOLDERCANCELLATION
<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 />City of Santa Ana
<br />AUTHORIZED REPRESENTATIVE
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th floor
<br />Santa Ana, CA 92702
<br />© 1988-2016 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
<br />SR ID:
<br />BATCH:
<br />26347216
<br />3593551
<br />
<br />
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