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AIRSREN-01
<br />CNARDUZZI
<br />�►co�ro„ CERTIFICATE OF LIABILITY INSURANCE
<br />`.�•-
<br />DATE(MM/DD/YYYY)
<br />'
<br />4/24/2024
<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 C TACT
<br />Basin Pacific Insurance & Benefits D i g i t o ) 000 FAX )
<br />(A/C, No): (509 470-6272
<br />110 West 6th Ave, #305
<br />Ellensburg, WA 98926 �� E-MAILcnarduzzi@basinpacific.com
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />An 9 ie
<br />INS ERA:CNA
<br />INSURED cevI B:StarStone National Insurance Company
<br />25496
<br />Airstreams e : o nsation Insurance Fund
<br />35076
<br />�e
<br />785 Tucker evedoDate.
<br />Tehchap'
<br />INSURERE:
<br />09-1 I r
<br />COVERAGES CERTIFIC^ :E 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
<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 />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />X
<br />X
<br />6057171294
<br />5/1/2024
<br />5/1/2025
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />100,000
<br />$
<br />X
<br />MED EXP (Any oneperson)
<br />$ 15,000
<br />Owner's & Contractor
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY ❑ PRO ❑ JECT LOC
<br />PRODUCTS - COMP/OPAGG
<br />$ 2,000,000
<br />WA STOP GAP
<br />$ 1,000,000
<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 />6057171702
<br />5/1/2024
<br />5/1/2025
<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 />B
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />Y82201240AEM
<br />5/1/2024
<br />5/1/2025
<br />AGGREGATE
<br />$
<br />DED RETENTION $
<br />$ 5,000,000
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y / N
<br />ANY ECUTIVE
<br />!�
<br />934514823
<br />8/28/2023
<br />8/28/2024
<br />PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />OFFICER/MEMBER/EXCLUDED? ❑
<br />(Mandatory in NH)
<br />N /A
<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 />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The City of Santa Ana, its officers, officials, employees, agents, volunteers and representatives are included as an Additional Insured with Waiver of
<br />Subrogation, per contract. Such insurance as is afforded and shall be primary, and any insurance carried
<br />by City shall be excess and noncontributory.
<br />Thirty (30) day prior written notice of cancellation will be provided to certificate holder.
<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 PRC RiskMougmumtDMslcrn
<br />Risk Management Division E
<br />20 Civic Center Plaza if REVIEWED & APPROVED BY:
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE °% •'j•;`� .."
<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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