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AC "Rl�
<br />,� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />7/17/24
<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 endorsements .
<br />PRODUCER
<br />CONTACT Tamm Lafata
<br />NAME,J.S.
<br />PHONE . 619-339-4197 'C No: 619-938-3416
<br />Tucker Insurance Services
<br />E-M5330
<br />ADDRESS: tammy@jstuckerins.com
<br />Carroll Canyon Road #110
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Sentinel Insurance Company
<br />11000
<br />San Diego CA 92121
<br />INSURED
<br />INSURER B : Travelers Casualty Ins Co of America
<br />38342
<br />INSURERC: Hartford Casualty Insurance Company
<br />29424
<br />Interpreters Unlimited, Inc.
<br />INSURERD: Mount Vernon Fire Insurance Company
<br />26522
<br />c/o PO Box 27660
<br />INSURERE: Stratford Insurance Company
<br />40436
<br />INSURERF: ACE American Insurance Company
<br />San Diego CA 92198
<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
<br />LTR
<br />OF INSURANCE
<br />ADDLSUBRTYPE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />MM/DDPOLICY EFF
<br />MM/ pY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />X
<br />X
<br />72SBAAR7770
<br />1/1/24
<br />1/1/25
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />$ 300,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />POLICY LX ECT LOC
<br />PRODUCTS - COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />BA-ON47027023
<br />1/13/24
<br />1/13/25
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED v NON -OWNED
<br />AUTOS ONLY !� AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />A
<br />X
<br />UMBRELLA LAB
<br />x
<br />OCCUR
<br />72SBAAR7770
<br />1/1/24
<br />1/1/25
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N
<br />OFFICER/MEMBER EXCLUDED? Y j
<br />(Mandatory in NH)
<br />N/A
<br />X
<br />72WEC108041
<br />1/1/24
<br />1/1/25
<br />PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<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 />D
<br />Professional Liability/E&0
<br />PT2001159B Date -full prior
<br />1/31/24
<br />1/31/25
<br />$3,000,000/agg
<br />$7,500 retention
<br />F
<br />E
<br />Cyber/Privacy incl Crime/Fidelity
<br />Cyber/Network/Privacy Liability
<br />D95194746
<br />PDO9003192
<br />1/1/24
<br />9/18/23
<br />1/1/25
<br />9/18/24
<br />$1,000,000/agg
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />30 day notice of cancellation except 10 day for nonpayment of premium
<br />Additional insured is (when required in written contract or agreement): City, its City Council, its officers, employees, agents and volunteers per
<br />attached general liability policy form SS0008 0405 including primary and non-contributory as well as waiver of subrogation favor of same.
<br />Additional insured also applies in favor of same per attached automobile liability policy form CAT420 0215 and CAT474 0216 including waiver of
<br />subrogation in favor of same. rimary and non-contributory in favor of same per attached automobile liability policy form CAT474 0216.
<br />Workers compensation waiver of subrogation applies in favor of same per attached policy form WC00 0313
<br />CERTIFICATE HOLDER CANCELLATION
<br />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 />ACCORDANCE WITH THE POLICY PR .
<br />Risk Management Division Risk Maug+:madDh6ion
<br />120 Civic Center Plaza AUTHORIZED REPRESENTATIVE 3� y� z REVIEWED& APPROVED BY.
<br />Santa Ana CA 92701 ,� `lI 1J L' "Ak
<br />-�� Risk Management Specialist
<br />0 1988-2015 AC15RD All rignts reserve
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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