|
t /:
<br />INFOINC-01
<br />SHEHNER
<br />A�Ol2L7 CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM 19 )
<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 License # OM70471
<br />Orion Risk Management Insurance Services, An Alera Group Insurance
<br />Agg@icy, LLC
<br />1800 Quail Street, Suite 110
<br />CONTACT
<br />PHONE
<br />AIc, No, Eat: (949)263-8850
<br />FA%
<br />A/C, 40:(949)263-8860
<br />E-MAIL
<br />INSURERS AFFORDING COVERAGE
<br />NAICtt
<br />Newport Beach, CA 92660
<br />INSURER A: Federal lnBUranCe COm an
<br />20281 _
<br />INSURED
<br />INSURER B:AXIS Insurance Company
<br />37273
<br />INSURER c:
<br />INFOSEND, Inc./ Rezai & Son, LLC
<br />INSURER 0,
<br />4240 E. La Palma Ave
<br />Anaheim, CA 92807
<br />INSURER E:
<br />NSURERF:
<br />f1nVFRAr1F9 CERTIFICATE Nt1MRER- REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO 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 />LTRA
<br />TYPEOFINSURANCE
<br />ADDLSUBDR
<br />POLICY NUMBER
<br />POLICY SEE
<br />POLICY EXP
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACtI OCCURRENCE
<br />g 1,000,000
<br />CLAIMS -MADE OCCUR
<br />36031149
<br />2/1/2019
<br />2/1/2020
<br />Dmm�cE TO RCNTED
<br />na- I E Ea pa. Pn�
<br />1,000,000
<br />$ _
<br />MEDEXP An one ersoN
<br />S 10,000
<br />PERSONAL 8 ADV INJURY
<br />g 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />X POLICY ❑ JET LOG
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMPIOP AGG
<br />S 2,000,000
<br />$
<br />OTHER
<br />A
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />accident
<br />$ 1,000,000
<br />BODILY INJURY Ppr cersaN
<br />s
<br />X ANY AUTO
<br />73587120
<br />2/1/2019
<br />211/2020
<br />BODILY INJURY Per accident
<br />S
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />yyN p
<br />X AUTOS ONLY X AUOTOS ONLY
<br />PI'eracEcRltlon DAMAGE
<br />g
<br />S
<br />A
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />79896866
<br />2/112019
<br />2/1/2020
<br />AGGREGATE
<br />S 5,000,000
<br />X
<br />DEO I RETENTION$ 0
<br />A
<br />WORKERS COMPENSATION
<br />qND EMPLOYERs'LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE Y�
<br />�FFICERIMEMBER EXCLUDED? Y
<br />(Mantlalpry In Ni
<br />NIA
<br />71749812
<br />2/112019
<br />2/1/2020
<br />X PER STAT T OTH.
<br />F ER
<br />E.L. EACH AGCIDENr
<br />S 11000,000
<br />EL. DISEASE EA EMPLOYE
<br />S 1,000,000
<br />ELDISEASE
<br />_
<br />10000
<br />$ ,0,DEgo
<br />ne
<br />sCRtlIePsTIObNuOnFdeOrPERATIO Sbnldw
<br />B
<br />D&O; $26,000 DED
<br />P00100007249801
<br />2/1/2019
<br />211/2020
<br />E&O Limit
<br />5,000,000
<br />B
<br />Cyber; $25,000 DED
<br />P00100007249801
<br />211/2019
<br />211/2020
<br />CYBER-see desc below)
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached a more space is required)
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and represIlIntatives are hereby named
<br />as an additional insured with regards to General Liability. Waiver of subrogation applies to workers compensation. 2 /Z //�1 9
<br />J/
<br />CYBER:
<br />-SECURITY AND PRIVACY LIABILITY COVERAGE Limit $5,000,000
<br />���
<br />- CRISIS MANAGEMENT AND COMPUTER SYSTEM EXTORTION COVERAGE ENDORSEMENT Limit $1,000,000
<br />u
<br />City of Santa Ana
<br />PO Box 1954
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016103) U 198d-ZU1b AUUKO l UKI-i I IUN. Au ngms reserveu.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|