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/ ® <br />ACORV CERTIFICATE OF LIABILITY INSURANCE <br />DATE(SiMIDDTIYYY) <br />08/0512019 <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 NEGATNELY 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 pollcy(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 endorsemem(a). <br />Welch, Graham a Ogden Ins., Inc. <br />7723 Ashton Avenue <br />Manassas VA 20109; <br />CONPRODUCER Kdt11Y Vincent ACSR <br />(703) 530-t300 (70SJ 530.999q <br />. hvincenta"oins.comINSURER($)AFFORpND <br />COVEMNAICIf <br />CSU Producer Resources, Inc. <br />13037 <br />INSURED <br />The Olson Group LW <br />N Washington Street <br />600 <br />VA 22314F: <br />a: AcckiWM Fund General <br />MAC <br />12304 <br />C:300 <br />D:Suite <br />E:Alexandrla <br />CDYENAFShtl liCRllr'IYNIG RVVIVGI\. " <br />THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS <br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED SYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />Ism <br />TYPEOFINSURANCE <br />COMMFRGALGENERALLIABILItt <br />INSD <br />POU"NUMSM <br />MAT <br />NNI <br />LIMITS <br />EACHOCCt1MefaCE <br />S 1,000,0()0 <br />FIN <br />PREMISES EaPmnalm <br />S 100,000 <br />� OCCUR <br />MEO FJd' w } <br />$ 1,000 <br />CIAIMS-MADE <br />T <br />A <br />Y <br />CS00045016 <br />0211312019 <br />0213/2020 <br />: <br />pERSONALAADV INJURY <br />$ 1,000,000 <br />GEN'LAGGREGATE LIMRAPMff$PHL <br />POUCY ❑ JM LOC <br />GENERALAGOREC>/ITE <br />g 2,000,000 <br />PRODUCTS-COLp10PAGO <br />S 2,000,000 <br />OTHER: <br />AUTOMOBILE UJUNUTY <br />BIKED NGLEUMn <br />$ 1,000.000 <br />BOOILYINJURY(PWPMaan) <br />S <br />ANYAUTO <br />BODaY WOURY(Par udd" <br />S <br />A <br />04 13 SCHEOULEO <br />AUTOSONLY AUT <br />HIRED NON-OVMED <br />X AUTOS ONLY AUTO90NLY <br />CS00045016 <br />02713I2019 <br />02t13=20 <br />Par <br />$ <br />$ <br />A <br />x <br />UMBRELLA UAs <br />ExcEss uAB <br />OUR <br />cLAIMs.MADE <br />CSU 0068151 <br />02/1312019 <br />02/13/2020 <br />EACH OCCURRENCE <br />$ 6,000,000 <br />AGGREGATE <br />S 5,000,000 <br />DIED I I RE'TEIM S <br />WORKERS COMPENSATION <br />QR4 <br />XTrPT§AkTUTe 1 ER <br />S <br />B <br />AND EMPLOYERS' LNBILITY YIN <br />ANY PROPRIETORIPARTNER)EXECUTNE FN7 <br />OFFICERIMEMBER EXCWDED4 <br />(M.Wm la NH) <br />If yes, 4earnba,maer <br />DESCRIPTION OF OPERATIONS W. <br />NIA <br />WCV6089388 <br />03/14/2019 <br />03/14/2020 <br />EL EACH ACCIDENT <br />$ 1,000,000 <br />E.LDISEASE-EAEMPLOYEE <br />$ 1-000.000 <br />E.L DISEASE -POUCY LIMIT <br />S 1,000,000 <br />DESCRIPTION OF OPERATIONS /.LOCATIONS I VEHICLES (ACORD 101, AWRIPhI Remake BPRe4NIR miry W aeaeh4 Rmprt space Is Mulmd) <br />City of Santa Ana, its omcers, agents, and employees are named as Additional Insured as required by written contract, subject to policy forms and <br />conditions. <br />REVIEWED & APPROVED <br />By RIS MANAGEMENT DIVISION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana SAM NTHA M. LAMBERT ACCORDANCE WITH THE POLICY PROVISIONS. <br />City of Santa Ana SA <br />20 Civic Center Plaza <br />AUTHORIZED AEPraSENTATVE <br />4th Floor `.! <br />Santa Ana CA 92710 <br />All Hams reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />