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FrancineR. <br />e <br />Villareal Dace, M20MOS 100e:a2 <br />A41cl CERTIFICATE OF LIABILITY INSURANCE <br />�i <br />DATE(M /202YYY) <br />7/31 /2020 <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 <br />Assured Partners I Hall & Company <br />A/E Insurance Services <br />1966010th Ave NE <br />CONTACT <br />NAME: Julia Ardon CA Lic #OF83966 <br />PHONE FAX <br />Alc No Ext: 360-626-2956 LAIC No:360-626-2956 <br />ADDRESS: julia.ardon@assuredpartners.com <br />INSURER(S)AFFORDING COVERAGE <br />NAIC# <br />Poulsbo WA 98370 <br />INSURERA: Argonaut Insurance Company <br />19801 <br />INSURED PHIILMAIR-02 <br />INSURER B: RLI INSURANCE COMPANY <br />13056 <br />Phil Martin & Associates <br />1809 E. Dyer Road, Suite 301 <br />INSURER C: <br />INSURER D: <br />Santa Ana CA 92705 <br />INSURER E <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: 2147050361 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 />OF INSURANCE <br />ADDLSUBRTYPE <br />INSO <br />MO <br />POLICYNUMBER <br />POLICY EFF <br />MMIDDYYYY <br />POLICYEXP <br />MMIDDYYYY <br />LIMITS <br />B <br />X <br />COMMERCIAL GENERAL LIABILITY <br />PSB0008850 <br />6/1/2020 <br />9/5/2020 <br />EACH OCCURRENCE <br />$1,000,000 <br />CLAIMS -MADE 1XI OCCUR <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence) <br />$1,000,000 <br />MED EXP (Any one person) <br />$10,000 <br />PERSONAL& ADV INJURY <br />$1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$2,000,000 <br />Fyl POLICY PEP LOC <br />PRODUCTS-COMP/OP AGO <br />$2,000,000 <br />$ <br />OTHER: <br />B <br />AUTOMOBILE <br />LIABILITY <br />PSB0008850 <br />6/1/2020 <br />9/5/2020 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$1,000,000 <br />BODI LV I NJURY(Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTO$ <br />BODI LY I NJURV(Per accident) <br />$ <br />X <br />HIRED N NON -OWNED <br />AUTO$ ONLY AUTO$ ONLY <br />PROPERTY DAMAGE <br />Per accitlenl <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />PER OTH- <br />STATUTE ER <br />ANYPROPRIETOMPARTNER/EXECUTIVE <br />EL EACH ACCIDENT <br />$ <br />OFFICEPoMEMBER EXCLUDED? ❑ <br />N/A <br />E. L. DISEASE - EA EMPLOYE <br />$ <br />(Mandatory in NH) <br />If as, describe under <br />DESCRIPTION OF OPERATIONS below <br />I <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />A <br />Professional Liab, Claims Made <br />121 AE0154726-00 <br />9/5/2019 <br />9/5/2020 <br />PerClaim <br />$1,00Q000 <br />Aggregate <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 />The certificate holder is an additional insured per the attached. <br />City of Santa Ana, officer, agents employees and volunteers are an Additional Insured on the Commercial General Liability and Auto Liability when required by <br />written contract or agreement regarding activities by or on behalf of the Named Insured. The Commercial General Liability insurance is primary insurance and <br />any other insurance maintained by the Additional Insured shall be excess only and non-contributing with this insurance. A waiver of subrogation applies to the <br />Commercial General Liability and Auto Liability in favor of the Additional Insured. Certificate of Insurance shall provide thirty (30) day prior written notice of <br />cancellation to the Additional Insured. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />Risk Management Divison <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana CA 92701 <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 />AUTHORIZED RRREEPRESENTATNE <br />Jkvt� <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />Risk Mansgslnent Diuisian <br />ram. <br />REVIEWED &{APPRO�V�ED By., <br />oll lli111-1� /-z' rb6HlM�e vdt i t¢bl. <br />® Risk Management Analyst <br />