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ACORO® CERTIFICATE OF LIABILITY INSURANCE 1.1 DATE(MMIDDffYY) 11/09/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(los) 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 on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Partee Insurance Associates, Inc. PTL Insurance Brokers, Inc. CONTACT NAME: Richard Pedevillano PHONE (626) 967-9581 AArc X N0:(626) 967-1864 P.O. Box 4155 Covina CA 91723 EMAIL ADDRESS, certificates® tlinsurance.com INSURERS AFFORDING COVERAGE NAIC4 Y INSURERA: Ohio security Insurance Co. 34082 BZS56380327AMAGE INSURED (714) 879-5000 BDL Cores & Cone INSURERS American Fire & casualty Co. 24066 INSURERC:Twin city Fire Insurance Co. 29459 120 S. State College Blvd. Suite #200 Brea, CA 92821 INSURER O: INSURER E NSURERF: CUVEHAGES CFRTIFICATF NIIMRFR-Cert Tn 41 RR oC%IlQl 1M M11101112=0 - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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. INSRAODL LTR TYP E OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SUER POLICYNUMBER POLICY EFF IMM1DDfYYYYf POLICY EXP fMM1DDIYfYYILIMITS City of Santa Ana A TCOMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y Y BZS56380327AMAGE 11/15/2018 11/15/2019 EACH OCCURRENCE $ 2,000,000 TO PREM SES Ea occu ante $ 2,000,000 MED EXP (Any one person) $ 15,000 PERSONAL B ADV INJURY $ Included GEN'L AGGREGATE LIMIT APPLIES PER: % POLICY ❑ PRO- ECT LOC GENERAL AGGREGATE It 4,000,000 PRODUCTS-COMP/OPAGG $ 4,000,000 S OTHER: AUTOMOBILELIABILIW COMBINED SINGLE LIMIT Ea acatlertl $ 11000,000 BODILY INJURY (Per person) $ AANY AUTO Y Y BAS119156380327 11/15/201811/15/2019 OWNED SCHEDULED AUTOS ONLY AUTOS (Per accitlenl BODILY INJURY (P $ ) X HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY PROPERTY DAMAGE Per accident)$ S g X UMSRELLAUAB % OCCUR USA(19)56380327 11/15/2018 11/15/2019 EACH OCCURRENCE $ 11000,000 AGGREGATE $ 11000,000 EXCESS UAB CLAIMS -MADE DED I X 1 RETENTIONS 10,000 Prod -Com s $ 1,000,000 A WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTN EWEXEC UTIVEE.L. OFFICER/M EM BER EXCLUDED? ❑ N/A Y MS(19)56380327 11/15/2018 11/15/2019 PER OTH- X STATUTE ER $ EACH ACCIDENT 11000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, descnhe under DESCRIPTION OF OPERATIONS below I I E.L. DISEASE -POLICY LIMIT $ 1,000,000 C Professional Liability 72PGO260349 11/15/2018 11/15/2019 Each Claim $ 1,000,000 Aggregate $ 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The City of Santa Ana, its officers, employees and agents are named Additional Insured with primary & noncontributory wording and Waiver of Subrogation applies per End. attached with regard to General Liability policy. With regard to Auto Liability policy, Additional Insured and Waiver of Subrogation End. is attached. With regard to Workers- Compensation policy, Waiver of Subrogation End. is attached. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana P P.O. Box 1964 • AUTHORIZED REPRESENTATIVE Santa Ana CA 92702 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1