|
�...44, EVERSOL-01 EREDMON
<br /> ,4coRO° CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDlYYYY)
<br /> `-..----- 9/12/2024
<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 CONTP.CT
<br /> NAME
<br /> Hub International Florida PHON: l�,pp
<br /> 1117 Thomasville Road INC,I o E� N.. i 827
<br /> Tallahassee,FL 32303 ngie E-MAII
<br /> ADDRE=S: /'�
<br /> Aceved JORDING COVERAGE NAIC#
<br /> INSI'iER, :Cincinnati Indemnit Corn any 23280
<br /> INSURED IN'dRER B D ._ " t..j j '( gelf npany 29424
<br /> Evergreen iot L e d O .ISURERC:Twin c.iuu�Fire Insurance Company 29459
<br /> 2528 Barri to lie eii20 INSURER D /� Q
<br /> Tallahassee,FL 32308 su R 1 2�02.'TV —O� QO
<br /> INSURER E:
<br /> INSURER F: I
<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 I POLICY EXP LIMITS LTR INSD WVD IMMIDDIYYYY) (MMIDDIYYYY) _
<br /> A I X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR ENP0586601 8/17/2024 8/17/2025 DAMAGETORENTED 500,000
<br /> X X PREMISES(Ea occurrence) $
<br /> MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X j POLICY PRO-
<br /> JECT LOC PRODUCTS-COMP/OP AGG, $ 2,000,000
<br /> OTHER: 'I $
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> (Ea accident) $
<br /> ANY AUTO ' X X EBA0586601 8/17/2024 8/17/2025 BODILY INJURY(Per person)_ $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident)_ $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY (Per accident) $
<br /> . I $
<br /> A I X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000
<br /> 1- EXCESS LIAB CLAIMS-MADE ENP0586601 8/17/2024 8/17/2025 AGGREGATE $ 2,000,000
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION
<br /> AND EMPLOYERS'LIABILITY Y/N X �•21 WECAB81M0 10/24/2023 10/24/2024 X STATUTE OTH-
<br /> ER 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? N I A
<br /> (Mandatory in NH) 1,000,000
<br /> E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $
<br /> C Professional Liab 21 PG 0567622-24 8/17/2024 8/17/2025 Per Claims 3,000,000
<br /> C Professional Liab 21 PG 0567622-24 8/17/2024 1 8/17/2025 Aggregate 3,000,000
<br /> i
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Santa Ana is included as an Additional Insured for General Liability&Auto Liability,&Waiver of Subrogation applies for General Liability,Auto
<br /> Liability,&Workers'Compensation,when required in a written contract or agreement with the Insured,per the terms&conditions of the policies
<br /> endorsements.Umbrella/Excess coverage is subject to(follows)the terms&conditions of the underlying General Liability,Auto Liability,&Employers'
<br /> Liability policy endorsements.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIRFn POLICIES BE CANCELLED BEFORE
<br /> Cityof Santa Ana THE EXPIRATION DATE THEREO\
<br /> ACCORDANCE WITH THE POLICY PR(
<br /> 20 Civic Center Plaza a,Ioa ,E RIskMoutgemeritD[vislrm
<br /> 92701 3 `s� REVIEWED&APPROVED BY:
<br /> AUTHORIZED REPRESENTATIVE 9.14II ;.• h !)
<br /> �' 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 />
|