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____..--...41 CHAMGRO-01 RENAS
<br /> `4��R� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 5/10/2024
<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#0M10410 j CCONT•CT
<br /> Armstrong/RobitaillelRiegle Business and Insurance Solutions Dig A; N oig� �_ OAng i-e FAX
<br /> 1500 Quail St,Suite#100 (A/C,No):(949)861-9429
<br /> Newport Beac1•I CA 92660 • /� �� ACe gp.ceve _INSURER(5r)1�AF�FO�RIDING CO^V�ERAGE _ NAIC#�a @/ �m D17370 INSUREDge
<br /> _07II • ER B_Key_Risk Insurance Company 10885.
<br /> Chambers Group Inc. '-4WJRER c:Insurance_ Co of the West 27847
<br /> 3151 Airway Ave,Suite F208 INSURER 0:
<br /> Costa Mesa,CA 92626 - -
<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 IMM/DD/YYYYI (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR ECP2026303-16 5/12/2024 5/12/2025 DAMAGES iroNci D 100,000
<br /> X X PREMISES R occurrence) $ _
<br /> MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ _ 1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY x PEA LOC PRODUCTS-COMP/OPAGG $ 1,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> (Ea accident) $
<br /> X ANY AUTO BAP2037737-12 5/12/2024 5/12/2025 BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS pBODILY INJURYp (Per accident) $
<br /> X AUTOS ONLY _X. AUUTO ONLYY (Perr accident AMAGE $
<br /> $
<br /> A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000
<br /> X EXCESS LIAB CLAIMS-MADE FFX2026322-16 5/12/2024 5/12/2025 AGGREGATE $ 10,000,000
<br /> DED RETENTIONS $
<br /> C WORKERS COMPENSATION X STATUTE OTH-
<br /> ER
<br /> AND EMPLOYERS'LIABILITY YIN WSD 5055233 04 5/12/2024 5/12/2025 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE _E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? N/A
<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 /> A Pollution Liability ECP2026303-16 5/12/2024 5/12/2025 Limit 1,000,000
<br /> A Professional Liab. ECP2026303-16 5/12/2024 5/12/2025 Limit 1,000,000
<br /> DESCRIPTION OF OPERATIONS I 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 included as additional insured per the attached form. Waiver of Subrogation applies to the
<br /> General Liability policy per the attached form. Primary/Non-Contributory wording applies to the General Liability policy per the attached form.30 Day Notice
<br /> of Cancellation with the exception of 10 days for non-payment of premium.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBFD POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREO\
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PR( Risk ManagemattDtviston
<br /> Risk Management Division .-"'.
<br /> 20 Civic Center Plaza 2, REViEwm&APPROVED BY:
<br /> Santa Ana,CA 92702 AUTHORIZED REPRESENTATIVE 1I,, 1. A' A6evda
<br /> 7)aw � •.,
<br /> �4�' Risk Management Specialist
<br /> I
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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