|
,acoRo® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE{MWDDIYYYY)
<br />09/09/2024
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER. 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
<br />g9 pp
<br />GreggStapp Insurance ServicesAngi
<br />CONTACT DOI S' Ons,
<br />PHONE 14
<br />A N ( _ ) N
<br />810 E. Commonwealth Ave
<br />E-MAIL ADDRESS: sta 36 ol.com
<br />F
<br />I MA!OVERAGE
<br />NAIL 0
<br />INSURER A : V ,nsa SUr nCe
<br />3
<br />Fullerton CA 92831
<br />INSURED p � evedo
<br />Upland SecurityGr
<br />INSURER B : IVatln�' - �I } I p y p y
<br />INSURER : Kinsale m an
<br />38920
<br />INSVAE', D
<br />1615 French St
<br />INSURER E :
<br />201
<br />INSURERF:
<br />Santa Ana CA 92701-
<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 />CERTIHGATE 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 />ADOL
<br />5UBR
<br />NUMBER
<br />POLICPOLICY
<br />MMIDDYIYYYY
<br />MM DDNYYY
<br />LIMITS
<br />x
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1 ,000,000,00
<br />�/
<br />CLAIMS -MADE X OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 100,000.00
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL aADVINJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />Y
<br />0100318355-0
<br />08/15/2024
<br />08/15/2025
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000.00
<br />GEN'L
<br />POLICY JrC7 X LOC
<br />PRODUCTS - COMPIOPAGG
<br />$ 2,000,000.00
<br />Seff Insured retention
<br />$ 2,500
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000.00
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />B
<br />X
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Y
<br />Y
<br />73APBOO7393
<br />10/26/2023
<br />10/26/2024
<br />BODILY INJURY (Per acident)
<br />$
<br />XHIRED
<br />NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />rx
<br />PROPERTYDAMAGE
<br />Per accident
<br />$
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000,00
<br />AGGREGATE
<br />$ 5,000,000,00
<br />C
<br />X
<br />EXCESS LIAS
<br />CLAIMS -MADE
<br />Y
<br />Y
<br />0100318721-0
<br />08/15/2024
<br />08/15/2025
<br />DED RETENTION$
<br />$ 5,000,000,00
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNER/EXECUTIVE —
<br />OFFICERIMEMBER EXCLUDED? ry
<br />NIA
<br />Y
<br />PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$
<br />E.L. DISEASE - EA EMPLOYE
<br />$
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />Professional Liability
<br />A
<br />Y
<br />Y
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Scheduie, maybe attached if more space is required)
<br />The below certificate holder to be named as additional insured.
<br />City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers are to be covered as additional insureds with respect to liability
<br />arising out of work or operations performed by or on behalf of the Permittee including materials, parts, equipment, and personnel furnished in connection with
<br />such work or operations.
<br />*10 day notice of cancellation applies in the event of non payment of premium.
<br />City of Santa Ana
<br />Risk Management Division
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 Civic Center Plaza
<br />Iaza
<br />THE EXPIRATION DATE THEREOF-
<br />NnTlre wu I. BE ❑ELIVFRFD IN
<br />ACCORDANCE WITH THE POLICY PR(
<br />Santa Ana, 92702
<br />o nr Risk Mzugmad Dnnskm
<br />AUTHORIZED REPRESENTATIVE
<br />r
<br />S REVIEIrWEi6APPROVEO8r
<br />Risk Management Spedalist
<br />OO 1988-2015 ACORD 11
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
|