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A C d CERTIFICATE OF LIABILITY INSURANCE <br />Gosno12o 0DY Y' <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 terns 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 />Marsh Risk & Insurance Services <br />17901 Von Kaman Avenue, Suite 1100 <br />an <br />CONTACT <br />NAME: <br />INC No PHONE FA% N <br />(949) 399-5BOO: License #0437153 <br />EAIAIL <br />ADDRESS <br />Irvine, CA W614 <br />Attn: NewpoftBeach.CertRequmt@mamh.wm/F: 212-9484323 <br />INSURERS AFFORDING COVERAGE <br />NAIC0 <br />INSURER A: Hartod Fire Insurance Company <br />19682 <br />CN10211i6416STND-GAWUP-2(F <br />INSUREDGnswold Industries, Cla-Val Company v/ <br />1701 Placentia Avenue <br />INSURER B : N/A <br />NIA <br />INSURER C : Tern City Fire Insurance Company <br />29459 <br />Costa Mesa, CA 926274475 <br />INR : N/A <br />N/A <br />INsuRERSUREEp : N/A <br />NIA <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: LOS-00243176D07 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 />IMSR <br />LTR <br />TYPE OF INSURANCE <br />AD <br />U <br />POLICYNUMBER <br />POLICY EFF <br />flMMDDPrYYY1 <br />POLICY UP <br />(MWDDrYYYY) <br />UWTS <br />A <br />X <br />COMMERCIALGENEM JAISRUTY <br />CLAIMS -MADE MOCCUR <br />$1,000,000 SIR <br />72ECSOA1987 <br />04/01/2020 <br />04,01021 <br />EACHOCCURRENCE <br />E I,000,000 <br />PREMISES$ <br />300,000 <br />X <br />MED UP orn pari <br />$ <br />PERSONAL &ADV INJURY <br />$ 1.000,000 <br />GENT AGGREGATE LIMIT APPLIES PER <br />X POLICY ❑ JECT LOC <br />OTHER' <br />GENERALAGGREGATE <br />$ 2.000,000 <br />PRODUCTS - COMP/OPAGG <br />$ 2,000,000 <br />$ <br />A <br />AUTOMOBILELIABILRY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOSHIRED X NO"WNED <br />AUTOS ONLY AUTOS ONLY <br />72UENUM3154 <br />04r01/2020 <br />0012021 <br />COMBINED SINGLE LIMIT <br />(Es Accident <br />$ 1000000 <br />BODILY INJURY(Per Person) <br />$ <br />J <br />BODILV INJURY (Paracaaenp <br />E <br />PROPERTY DAMAGE <br />Far awdem) <br />$ <br />E <br />UMBRELLA LIAR <br />EXCESS LIAR <br />OCCUR <br />CLAMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DIED RETENTION <br />E <br />A <br />C <br />WORKERSCOMPENSATIOH <br />AND EMPLOYERS' LMBILRY <br />ANYPROPRIETORIPARTNER/EXECU RIVE YIN <br />OFFICERIMEMBEREXCWDEDT <br />(Mandatory in NH) <br />eb <br />Use, ne.c e Uncer <br />SCRIPTIONCFOPERATIONShelow <br />NIA <br />72WNC93100(CA) <br />72WEH03564 (ADS) <br />O/g112020 <br />1 21 <br />04N1/2021 <br />/ <br />✓ <br />X STAT E OHH. <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE -EA EMPLOYE <br />$ IT0001000 <br />E.L DISEASE - POLICY LIMIT <br />E 1 �0.(X70 <br />DESCRIPTgN OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, AtlOKional Remarks Schedule, may M aeachad N more space Is reRuired) <br />The City of Sana Ana, its officers, employees, agents, volunteers, and representatives are included as additional insured (except workers' compensation) where requered by written contact. The insurance i5 <br />primary and rwn-contributory over any existing insurance and limited to kabihty arising out of the operations of the named insured subject to policy terms and Conditions; Mth respect to General Liability. ✓ <br />Ciryof Santa Ana By RISK MANAGEMENT DIVISION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Risk Management Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />20 Civic Center Plaza M �O•$O ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92702 <br />AUTHORUZEDREPRESENTATIVE <br />ANGIE ACEVEdo of Marsh Risk & Insurance Services <br />Pam Petersen <br />©1988-2016 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />