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GRUEASS-01 YCORATHERS
<br />,44coiz" CERTIFICATE OF LIABILITY INSURANCE
<br />��
<br />DATDIYYYY)
<br />11/61216/2024
<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(les) 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 />Acrisure Southwest Partners Insurance Services, LLC
<br />4000 Westerly Place
<br />Suite 110
<br />NANaeCT Mary Tang
<br />PHONE FAX
<br />A/C, No, Est): (A/C, No):
<br />%&�jss, mtang@acrisure.com
<br />Newport Beach, CA 92660
<br />INSURERS AFFORDING COVERAGE
<br />NAIC 9
<br />INSURERA:Valley Forge Insurance Company
<br />20508
<br />INSURED
<br />INSURER B: National Fire Insurance CO Of Hartford
<br />20478
<br />INSURER C: Continental Casualty Company
<br />20443
<br />Gruen Associates
<br />INSURERD: HSB Specialty Insurance Company
<br />14438
<br />6330 San Vicente Blvd. Ste 200
<br />Los Angeles, CA 90048
<br />INSURER E:
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER' REVISION NUMRFR-
<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 />TYPE OF INSURANCE
<br />INSD ADOLSUBR
<br />POLICY NUMBER
<br />POLICY SEE
<br />POLDfYYYYI ICY EXPLTR
<br />NYYYI
<br />LIMITS
<br />A
<br />X
<br />COMMERCRI-GENERALLIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />X
<br />6025612892
<br />61
<br />61112025
<br />EACH OCCURRENCE
<br />2,000,000
<br />DAMAGE TO RENTEBrice
<br />PREMISES (Ed
<br />1,000,000
<br />MED EXP (Any onePerson)
<br />10,000
<br />PERSONAL$ ADV INJURY
<br />2,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY [X]j&O LOC
<br />GENERAL AGGREGATE
<br />4,000,000
<br />GEN'L
<br />PRODUCTS-COMPIOP AGO
<br />4,000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />OMBINEDtSINGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJU RY Per arson
<br />$
<br />ANY AUTO
<br />6025604615
<br />61112024
<br />6/1/2025
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />P.,,ad dent AMAGE
<br />$
<br />X
<br />W
<br />AUyOS ONLY X AUTOS ONLY
<br />C
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />5,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />6025612973
<br />611/2024
<br />611/2025
<br />DED X RETENTION $ 10,000
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICER/MEMBER EXCLUDEDP
<br />(Mandatory in NH)DISEASE
<br />NIA
<br />X
<br />6025612939
<br />8/1/2024
<br />6/112025
<br />PER OTH-
<br />X ATUTE ER
<br />E.L. EACH ACCIDENT
<br />11000,000
<br />$
<br />- EA EMPLOYEE
<br />1,OOD,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />C
<br />Professional Liab.
<br />AEHOO8215536
<br />6/112024
<br />6/112025
<br />Each Claim/Aggregate
<br />5,000,000
<br />D
<br />Cyber Liability
<br />ATB-6617832-03
<br />1/1912024
<br />1/1912025
<br />Aggregate
<br />3,000,000
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The Professional Liability includes PDllu ion Liability coverage.
<br />policy
<br />Excess General Liability Policy #CCP1240352 Carrier: Century Surety Co.
<br />Policy Dates: 6/112024.6/112025 Each Occurrence 5,000,000/Aggregate $5,000,000 limits
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are additional Insured on a primary and non-contributory basis as respects
<br />attached General Liability endorsement SB300120-C and CNA80103, as required by contract. Waiver of subrogation applies as per attached General Liability
<br />form SE146968 and Workers Compensation form G19160. Separation of insureds provision is included. Umbrella Liability policy follows the General Liability
<br />SEE ATTACHED ACORD 101
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cityof Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016103) AFFKU- VI
<br />The ACORD name and logo are registered In 8y CynfMra Mora at
<br />
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