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<br />HOUS&HA-01 SGUILLEN
<br />ACORO' CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 0612212
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<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 License # OC36861
<br />CONTAkieACT
<br />Inland Empire-Alliant Insurance Services, Inc.
<br />735 Carnegie Dr Ste 200
<br />San Bernardino, CA 92408
<br />PHONE No, Exry: (909) SSB•9aS1 (AAiC, Nei SSS•2013
<br />A PAIL
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A:Colony Insurance Company
<br />39993
<br />INSURED
<br />INSURER B: Nationwide Mutual Insurance Company
<br />23787
<br />INSURER C: RSUI Indemnity Company
<br />22314
<br />Houston & Harris P C S Inc
<br />INSURER D:Cypress Insurance Company
<br />10855
<br />21831 Barton Road
<br />Grand Terrace, CA 92313
<br />INSURER E : Landmark American Insurance Company
<br />33138
<br />NSURERF:
<br />CGVFRAGES CERTIFICATE NUMBER' REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMED ABOVE FORTHE 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
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />103GLOO24297.00
<br />06/24/2018
<br />06,24,2019
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTEDn
<br />PREMISES EaMED
<br />$ 100,000
<br />UP (Any oneperson)
<br />$ 5,000
<br />PERSONAL _&ADV INJURY
<br />1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICYFK JReT LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />2,000,000
<br />PRODUCTS -COMP/OPAGO
<br />21000,000
<br />B
<br />AUTOMOBILE LIABILITY
<br />X ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUOTgOOS
<br />X AUTOG ONLY X AUTOS ONLY
<br />ACP3046645740
<br />06/2412018
<br />0612412019
<br />EO eBINED SINGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJURY Perperson)
<br />$
<br />BODILY INJURY Per accident
<br />$
<br />PeBaCCICe^I AMAGE
<br />$
<br />C
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />NHA245203
<br />06/2412018
<br />06/24/2019
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />$ 4,000,000
<br />DED 1 X I RETENTION$ 0
<br />D
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNER,EXECUTIVE V❑
<br />pFFICERIMEMWgR EXCLUDED?
<br />(Mandatory in NH)
<br />Dyes, describe under
<br />DESCRIPTION OF OPERATIONS be.
<br />NIA
<br />X
<br />HOWC807872
<br />0910112017
<br />09101/2016
<br />X STATUTE OTH-
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE - EA EMPLOYE
<br />1,000,000
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />E
<br />Prof. Liability
<br />LHR835107
<br />06124/2018
<br />0612412019
<br />AgglEach Claim Limit
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />Job: Agreement A 2014-t`l4+OL.
<br />City of Santa Ana is Additional Insured as respects to General Liability per endorsements attached. Waiver of Subrogation applies as respects to worker's
<br />compensation per endorsement attached.
<br />(pe, / �o
<br />City of Santa Ana
<br />Water Resources Division
<br />220 S. Daisy Ave.
<br />Santa Ana, CA 92703
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />ACORD 25 (2016/03) 01988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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