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DATE (MM/DD/YYYY) <br />ACOR" CERTIFICATE OF LIABILITY INSURANCE <br />9/26/2019 <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 endorsement(s). <br />PRODUCER NAIL: CONTA <br />Sherry Allen <br />SilverStone Group PHONE 402-964-5644 N�; <br />11516 Miracle Hills Drive EMAIL <br />Suite 100 ADDRESS, sellen ss i.com <br />Omaha NE 68154 INSURERS AFFORDING COVERAGE NAIC# <br />INSURERA: Liberty Insurance Corporation 42404 <br />INSURED INSURER e : Liberty Mutual Fire Insurance Co 23035 <br />DMS Facility Services LLC <br />DMS Facility Services Inc INSURERC: First Liberty Insurance Corp. 33588 <br />1040 Arroyo Drive INSURER D : AIG Specialty Insurance Company 26883 <br />South Pasadena CA 91030 INSURERE: <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 1555272138 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 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 KWLTYPE OF INSURANCE INSD WVDViYWR POLICY NUMBER POLICY <br />YYY) (MM/DDNYYYI LIMITS <br />B <br />X <br />COMMERCIALGENERALLIABILITY <br />TB2-691-458727-089 <br />10/1/2019 <br />10/1/2020 <br />EACH OCCURRENCE <br />$I,000000 <br />RENTED <br />CLAIMS -MADE X OCCUR <br />PREJvI SFSsU urrence <br />$ 100,000 <br />MED EXP (Any one person) <br />$ 10,000 <br />PERSONAL & ADV INJURY <br />$ 1.000.000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />POLICY jERO- LOC <br />PRODUCTS - COMP/OP AGG <br />$2.000.000 <br />$ <br />OTHER' <br />C <br />AUTOMOBILE <br />LIABILITY <br />AS6-691-458727-079 <br />10/1/2019 <br />10/1/2020 <br />COMBINED3INGLELIMIF <br />Ea acc dent <br />$1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />X <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTYDAMA <br />�� <br />$ <br />UMBRELLA LIAB <br />HCLAIMS-MADE <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />QED I I RETENTION <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILITY YIN <br />WA7-69D458727-069 <br />10/1/2019 <br />10/1/2020 <br />X STATUTE R <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />OFFICERIMEMBER EXCLUDED? ❑ <br />NIA <br />E.L, DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />D Contractors Pollution <br />CP016083633 <br />10/1/2019 <br />10/1/2020 <br />Each Loss <br />$1,000,000 <br />Liability <br />Aggregate <br />$1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Additional insured an a primary and non-contributory basis With respects to General Liabilityy, Including completed operations, as required by written contract: <br />City of Santa Ana, Risk Management, it's officers, employees, agents, representatives, and valunteers. <br />1Walver of Subrogation with respects to Workers Compensation as required by written contract. <br />30 days' Notice of Cancellation provided with respects to General Llability, Auto and Workers Compensation as required by written contract. <br />BE I WM D & APPRpOVEoD <br />Y <br />L;LK I IFIC:A I r HULutK 111-.1 Ili IU 13 // GANUEL.LA I WN <br />City of Santa Ana FRA <br />Risk Management Division <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana CA 92702 <br />f�' <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />INN R• VI LAREA THE ORDAEXPIRicETION W THDATTHE POLICY CY THEREOF, <br />NOPROIOTICE WILL BE DELIVERED IN <br />ACC <br />AUTHORIZED REPRESENTATIVE <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />