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Clinntti• 191;11RR
<br />Digitally signed by Francine
<br />Francine R.
<br />R. Villareal
<br />3n5Cr1CFINC x/ill__,i Date: 2021.05.1315:03:04
<br />�~
<br />ACORD.,,, CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />3/09/2021
<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 any rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT Lori Ricke
<br />NAME:
<br />McGriff Insurance Services
<br />PHONE 714 941-2909 FAX
<br />2400 E Katella Ave Suite 1100
<br />A/C, No, Ext : (A/C, No):
<br />E-MAIL ADDRESS: Iricke@mcgriff.com
<br />Anaheim, CA 92806
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />714 941-2800
<br />INSURER A: Continental Casualty Company
<br />20443
<br />INSURED
<br />INSURER B : Continental Insurance Company
<br />35289
<br />CDCE, Inc
<br />INSURERC: Transportation Insurance Company
<br />20494
<br />22641 Old Canal Road
<br />Y Valle Fore Insurance Company
<br />INSURER D: 9 p Y
<br />20508
<br />Yorba Linda, CA 92887
<br />INSURER E
<br />INSURER F :
<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 CONTRACTOR 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 />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSR
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE L* OCCUR
<br />X
<br />X
<br />4013661900
<br />3/09/2021
<br />03109/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />PREMISES (ERENTED
<br />rrrence)$1,000,000
<br />MED EXP (Any one person)
<br />$15,000
<br />PERSONAL & ADV INJURY
<br />$1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICYFx] JECOT LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />PRODUCTS-COMP/OPAGG
<br />$2,000,000
<br />$
<br />D
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON -OWNED
<br />AUTOS ONLY X AUTOS ONLY
<br />6057616617
<br />3/09/2021
<br />03/09/202
<br />COEaMBINED accidentSINGLE LIMIT
<br />$1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />B
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />4013661914
<br />03/09/2021
<br />03/09/2022
<br />EACH OCCURRENCE
<br />$5 000 000
<br />AGGREGATE
<br />$5 00O 000
<br />DED I X RETENTION $10000
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N
<br />OFFICER/MEMBER EXCLUDED? [y]
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N / A
<br />WC4016477777
<br />06/08/2020
<br />06/08/2021
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: Reference Agreement A-2016-361
<br />The City of Santa Ana, its officers, employees, agents, and representatives are named as Additional Insured with primary wording
<br />and waiver of subrogation as respects to General Liability, as required by written contract, per attached CNA74872XX.
<br />Separation of Insureds applies to General Liability per attached CG0001. Additional Insured applies to Auto Liability, as required by
<br />written contract, per attached CNA71526XX. 30-Day Notice of Cancellation per attached CNA74702XX.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />y
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL
<br />BE DELIVERED IN
<br />Risk Management Division
<br />ACCORDANCE WITH THE POLICY
<br />PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />�oRaN
<br />Ii:AManagmerltDMsian
<br />A
<br />z
<br />REVIEWED & APPRCYVED BY:
<br />v'
<br />© 1988-2015 ACORD
<br />ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br />Risk Management Analyst
<br />#S27499609/M27497184
<br />
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