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Digitally signed by Francine R.
<br />Francine R. Villareal Villareal
<br />Date: 2021.01.281638:12-08'00'
<br />HOUS&HA-01 SGUILLEN
<br />ACORO"° CERTIFICATE OF LIABILITY INSURANCE
<br />�..•--�'
<br />FDATE TE(MM/DD/YYYY)
<br />1/26/2021
<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 rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER License # OC36861
<br />CONTACT
<br />NAME:
<br />PHONE FAX -2013
<br />(A/C, No, Ext): (909) 886-9861 No):(909) 886
<br />Inland Empire-Alliant Insurance Services, Inc.
<br />685 Carnegie Dr Ste 265
<br />San Bernardino, CA 92408
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: ColonyInsurance Company
<br />39993
<br />INSURED
<br />INSURERB: Nationwide Mutual Insurance Company
<br />23787
<br />INSURER C: Travelers Casualty and Surety Company of America
<br />31194
<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 />INSURERE: Landmark American Insurance Company
<br />33138
<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 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 />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<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 />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />103GL0024297-02
<br />6/24/2020
<br />6/24/2021
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />100,000
<br />$
<br />IVIED EXP (Any oneperson)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY X JECT El LOC
<br />PRODUCTS - COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />X
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />X
<br />X
<br />ACP3066645740
<br />6/24/2020
<br />6/24/2021
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />C
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />ZUP-41N13398-20-NF
<br />6/24/2020
<br />6/24/2021
<br />AGGREGATE
<br />$ 4,000,000
<br />DED X RETENTION $ 10,000
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />X
<br />HOWC116572
<br />9/1/2020
<br />9/1/2021
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />(Mandatory in NH)
<br />N/A
<br />E.L. DISEASE- EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />E
<br />Prof Liability
<br />E
<br />0572
<br />7
<br />6/24/2020
<br />6/24/2021
<br />Agg/Each Claim Limit
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Job: Agreement A-2017-364-01 and A-2017-223-01.
<br />City of Santa Ana is an additional insured, waiver of subrogation as respects to general liability per endorsements attached; additional insured, waiver of
<br />subrogation as respects to auto liability per endorsement attached; waiver of subrogation as respects to workers compensation per endorsement attached.
<br />Cancellation Notice, per attached endorsements.
<br />CANCELS AND REPLACES THE CERTIFICATE ISSUED ON 9/2/2020.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />ty
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL BE DELIVERED IN
<br />Risk Management Division
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Drive
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />RAMwaganerdUlMslan
<br />REVIEWED & APPROVED BY.-
<br />V
<br />mC P, Mud
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD C
<br />The ACORD name and logo are registered marks of ACORD
<br />'-�'
<br />Risk Management Analyst
<br />
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