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NAIC # 1,000,0001,000,0001,000,000 DHARVEY 27847 8/5/2020 DATE (MM/DD/YYYY) $$$$$$$$$$$ (800) 474-3003 LIMITS OTH- FAX(A/C, No): PERSTATUTEER X EACH OCCURRENCE$DAMAGE TO RENTEDPREMISES (Ea occurrence)MED EXP (Any one person)$PERSONAL & ADV INJURY$GENERAL AGGREGATE$PRODUCTS - COMP/OP AGGCOMBINED SINGLE LIMIT(Ea accident)BODILY INJURY (Per person)$BODILY INJURY (Per accident)$PROPERTY DAMAGE(Per accident)EACH OCCURRENCEAGGREGATEE.L. EACH ACCIDENTE.L. DISEASE - EA EMPLOYEE$E.L. DISEASE - POLICY LIMIT REVISION NUMBER: USNATIO-01 INSURER(S) AFFORDING COVERAGE © 1988-2015 ACORD CORPORATION. All rights reserved. (951) 506-5859 Insurance Company of the West ICW certs@orrandassociates.com POLICY EFFPOLICY EXP 11/14/201911/14/2020 (MM/DD/YYYY)(MM/DD/YYYY) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS. CONTACTNAME:PHONE(A/C, No, Ext):E-MAILADDRESS:INSURER A :INSURER B :INSURER C :INSURER D :INSURER E :INSURER F :CANCELLATION AUTHORIZED REPRESENTATIVE POLICY NUMBER WTX504443001 X The ACORD name and logo are registered marks of ACORD INSDWVDN / A ADDLSUBR CERTIFICATE OF LIABILITY INSURANCE Y / N CERTIFICATE NUMBER: LOC OCCURCLAIMS-MADE SCHEDULEDNON-OWNED PRO-JECT TYPE OF INSURANCE US National Corp dba Jimenez Painting Company10205 San Fernando RdPacoima, CA 91331 City of Santa AnaRisk Management Division20 Civic Center PlazaSanta Ana, CA 92702 CLAIMS-MADEOCCUR License # 0E63493 COMMERCIAL GENERAL LIABILITYPOLICYOTHER:ANY AUTOOWNEDAUTOS ONLYAUTOSHIREDAUTOS ONLYAUTOS ONLYUMBRELLA LIABEXCESS LIABDEDRETENTION$ GEN'L AGGREGATE LIMIT APPLIES PER:AUTOMOBILE LIABILITY WORKERS COMPENSATIONAND EMPLOYERS' LIABILITYANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?(Mandatory in NH)If yes, describe underDESCRIPTION OF OPERATIONS below THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s).THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. A PRODUCERINSURED COVERAGES DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)CERTIFICATE HOLDERACORD 25 (2016/03) LTR INSR Orr & Associates Insurance Services28780 Single Oak DrSte 255Temecula, CA 92590 Certificate is subject to policy limits, conditions and exclusions.City of Santa Ana, its officers, employees, agents and volunteers are named as certificate holders.