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<br />SGONZALEZ
<br />DA2H620224
<br />,a►`oRo` CERTIFICA
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<br />THIS CERTIFICATE ISSUEDMATTEELY R OFMATION�YOQNLLEEY%XAAJND CONF IS Tad UJj0 J�,C�F@�IFjCATE HOLDER. THIS
<br />EDIAS
<br />RATE DOES NOT RMAA NEGAF BY THE POLICIES
<br />CERBELOW.
<br />THIS CERTIFICATE OF INSURANCE DOES ON 1��t N THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIF TE LL'tl LL.. VV ����........ ����AAAA
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(lef, must hav^ ' _. ., .,_'NSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the polir 1, certain 24a0 5 endorsement. A statement on
<br />this certificate does not confer rights to the certificate ho in lieu of such end rsement s . LT••®
<br />PRODUCER License # 0757776 W JT Michelleyqxgqs
<br />HUB International Insurance Services Inc. PH1E
<br />3000 Executive Parkway (916) 7 18 , Nul:(951) 231-2572
<br />Suite300 °-MAIL .cal.cpu hubinternational.com
<br />San Ramon, CA 94583
<br />INSURERSINSURERSI AFFORDING COVERAGE NAIC If
<br />INSURER A: Colony Insurance Company 39993
<br />INSURED
<br />Insurance Com an
<br />INSURERB:Libe�Mutual Fire Insurance Company
<br />23035
<br />23035Fire
<br />INSURER C:The First Liberty Insurance Corporation
<br />33588
<br />Graffiti Protective Coatings, Inc.
<br />INSURER D:
<br />419 North Larchmont, #264
<br />Los Angeles, CA 90004
<br />INSURER E:
<br />INSURER F:
<br />CfTVFRAr:FC r.FRTIPICATF NIIMRFR- 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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 LTR
<br />TYPEOFINSURANCE
<br />ADOLSUBR INS2
<br />Min
<br />POLICY NUMBER
<br />POLICY EFFWwoDsyyYyT
<br />POLICY E%P
<br />Mi
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />g 1,000,000
<br />CLAIMS -MADE FA] OCCUR
<br />X
<br />X
<br />PACEP4246050
<br />2/17/2024
<br />2/17/2025
<br />DAMAGE T EREaNTED .gaim�
<br />PREMISESMED
<br />$ 100,000
<br />EXP (Any one erson
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY jEO 0 LOD
<br />GENERAL AGGREGATE
<br />11 2,000,000
<br />PRODUCTS-COMP/OPAGG
<br />2,000,000
<br />S
<br />OTHER:
<br />B
<br />AUTOMOBILE LIABILITY
<br />EOMBINED SINGLE LIMIT
<br />$2,000,000
<br />BODILY INJURY Per rson
<br />9.
<br />X ANY AUTO
<br />X
<br />X
<br />AS2491.466837.014
<br />1112024
<br />1112025
<br />BODILY INJURY Per accident
<br />$.
<br />ONMED SCHEDULED
<br />AUTOS ONLY AUr0p5
<br />PI2e0a nt AMAGE
<br />P
<br />$
<br />p
<br />AIRI'OS ONLY ABTO-0 ONLY
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I I RETENTION$
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />X PER OTH-
<br />AND EMPLOYERS' LIABILITY YIN
<br />ONFFICPERMIEMBOERIEXCLU�E�P ECUTIVE
<br />( enOaR Y nNH(
<br />NIA
<br />X
<br />C6-Z91-466837-024
<br />1/1/2024
<br />1/1/2025
<br />E.L. EACH ACCIDENT
<br />11000,000
<br />E.L. DISEASE -EA EMPLOYE
<br />1,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />I
<br />I
<br />I
<br />DESCRIPTION OFOPERATIONSILOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached K more space is mqulmou
<br />Re: Service Contract, Contractor Agreement: A-2020.155.
<br />City of Santa Ana, its officers, agents, employees and representatives are Additional Insured with regard to the General Liability policy, when required by
<br />written contract, per the attached endorsement forms EPACE101 08114 and EPACE100 08114. Coverage is Primary & Non —Contributory with regard to the
<br />General Liability policy, when required by written contract, perthe attached endorsement form EPACE107 07/14. Waiver of Subrogation applies to the General
<br />Liability policy, when required by written contract, per the attached endorsement form EPACE113 07114. Additional Insured applies with regard to the Auto
<br />Liability policy, when required by written contract, per the attached endorsement form AC8467 04/15. Waiver of Subrogation applies to the Auto Liability
<br />SEE ATTACHED ACORD 101
<br />City of Santa Ana
<br />Attn: Risk management
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLIc1ER BF CANCFI I.ED BEFORE
<br />THE EXPIRATION DATE THEREO
<br />ACCORDANCE WITH THE POLICY PR(
<br />AUTHORIZED REPRESENTATNE
<br />REMEwaAPFROv®IN: ,
<br />a�: ¢ IileleTIDrlmnBel Boveci ft
<br />' R+�:r Auvuta
<br />®� link Management Specialist
<br />ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<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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