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CERTIFICATE OF LIABILITY INSURANCE DATE Y) 1023/2019 2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED, the Pollcy(les) must have ADDITIONAL INSURED provisions or be andomed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not Confer rights to the Certificate holder In lieu of such endorsements). PRODUCER NAME: Lynene(Lynn) Eye PIA Select buu uacm Solutions An: No IROS) 975-3531 52, No): 1100 Industrial Rd., e3 ADDRESS: lymn.eye(gpiaselectcom INSURERS) AFFORDING COVERAGE NAIC e San Cal10S INSURER A : Amco Insurance Company 002014 CA 94070 INSURED INSURER B: Employers Insurance Group 10346 Data Ticket. Inc. INSURER C : DBA: Revenue Experts INSURER D : 2603 Main Str"L Ste. 300 InsURER E Irvine CA 92614 WSURER F: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80VE FOR THE POLICY PERIOD ABOVEOR THE P INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCHES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L R x TYPE OF INSURANCE COMMERCIAL GENERAL WaXT' CLAMS LADE XOCCUR INBD PAID POLICY NUA®ER MNn)D/YYY1') IMwODmyfT MISTS EACH OCCURRENCE S 2.000,000 PREMISES Ea ocourancs S 300.OD0 MED EXP (AM ma paean) S 5,000 A Y Y ACP BP0 3059509589 I V0112019 11 /01 2020 PERSONAL S ADV INJURY S Excluded OEENL p AGGREGATE LIMIT APPLIES PER: POLICY ❑JECaT 7LOC GENERN. AGGREGATE 3 4.000,000 PRODUCTS-COMP+OP AGG S 4,000,000 OTHER: S AUTOMOBILE UA81UTY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS HIRED AUTOSNONOWNED A1R090N1r Fa AUTOS ONLY ACP BP03059509589 II101 R019 II'OL202p (Ea aabenr s 1.000.000 BODILY INJURY {Por person) 9 BODILY INJURY (Par auitMAl S rattWnl S S A x UMBRELLA LIAR EXCESS UAS OCCUR CLAIMSJAADE ACP CAA 3059509589 11/012019 11:01:2020 EACH OCCURRENCE S ? 000,000 AGGREGATE S 2,000,000 DED I I RErEWION5 S 0 NE COMPEN"A NO EMPLOYEWLIABILITY YIN NY PROPRIETORNARTNER:F�CUTNE FFICEwrAEMSER EXLUDED+ MarMatary In NH) I yes. dawiea urger ESCRIPTION OF OPERATIONS Deb. NIA y EIG2869443 07/1212019 071I2/2020 y ^ STATUTE ER EL EACH ACCIDENT S I,000.000 E.L. DISEASE -EA EMPLOYEE S 1.000,000 E.L DISEASE -POLICY LRRT S 1.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 181. AdolUonal Remarks Seh"We, may ba atbew B I11ala aped M raqulnal) City of Santa Ana, officers. agents. employees. and volunteers are named as additional insured on the General Liability policy pursuant to written contract, agreement, or memorandum of understanding. The General Liability policy includes a Waivet of Subregation. Primary & Von -Contributory wording and 30 day notice of cancellation as required by written contract (see attached). Workers Compensation includes a blanket Waiver of Subrogation (see attached). 11MVIEWED & APPROVED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE By Risk NAGEMENT DIVISION ACCORDANCE WITH THE POLICY PROVISIOEXPIRATION DATE THEREOF, NOTICE NS. BE DELIVERED IN City of Santa Ana Risk Manegemem Division 272019 AI1TIr DREPREBENTATIVE -� 20 Civic Center Plain, 41h Floor oa ) Santa ACA 92702 CARAA AIr ... . _ �- S ACORD reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD