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ACOCERTIFICATE OF LIABILITY INSURANCE DATE(MY) 03lO6/2020Re /2020 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(ies) must have ADDITIONAL INSURED provisions or be endorsed. N 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 NAME: Nicole Noonan PHO%NE (703) 530-1300 uc No : (703) 530-9994 Welch, Graham B Ogden Ins., Inc. ADDRESS: nnoon.n@wgoins.corn 7723 Ashton Avenue INSURER(S) AFFORDING COVERAGE NAIL a INSURER A: CSU Producer Resources, Inc. Manassas VA 20109 INSURED / INSURER B: Accident Fund General 12304 INSURER C: The Olson Group Ltd J/ INSURER D: 300 N Washington Street INSURER E: Suite 600 INSURER F: Alexandria VA 22314 COVERAGES CERTIFICATE NUMBER: 20-21 REVISION NUMBER: 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. LTR TYPE OF INSURANCE IRM25a POLICY NUMBER MWDONYYY) (MMJDDNYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 CLAIM$ -MADE ® OCCURVAM'ES'(E=' S '00,000 MED EXP (An Pne erson) S 1.000 PERSONAL AADV INJURY S 1.000.000 A Y CS00045016 02/13/20220 (/ 02/1312021 / GENT. AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE f 2,000,000 PRODUCTS - COMPIOPAGG $ 2,000,000 POLICY ❑ J;CT 7 LOC S OTHER: I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s 1,000,000 BODILY INJURY (Per PMeon) S ANY AUTO BODILY IWURY IPer acdOmO S A OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY CS00045016 02/13i20?�D ✓ 02/13/2021 t� P nDAMA E tl 5 f UMBRELLALIAB OCCUR EACH OCCURRENCE S 5,000,000 A EXCESS LIAR CLNMS-MADE CS00068161 02/13/2020 02/13/2021 AGGREGATE S 5,000.000 DED RETENTION B WORKERS COMPENSATION AND EMPLOYERS LIABILITY YIN ANY PROPRIETORIPARTNERIE%ECUTIVE OFFICEWMEMBER EXCLUDED? (Mandatory In NH) NIA wCV6089388 03/14/2020 ✓ 03/14/2021 PER OT- IN TA ft E.L. EACH ACCIDENT S 1,000,000 EL. DISEASE - EA EMPLOYEE f 1,000,000 E.L. DISEASE -POLICY LINT f 1,000,000 H vas. tlescMevMx DESCRIPTION OF OPERATIONS OBImv DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD101. AddiOonal Remarks Schedule, may Oe aNachad H more apace Is mouired) / City of Santa Ana, its officers, agents, and employees are named as Additional Insured as required by Written contract, subject to policy forms and J Conditions. 30 day notice of cancellation applies, except for non-payment. v// REVIEWED & APPROVED By RISk MANAGEMENT DjVI510N City of Santa Ana 20 Civic Center Plaza 4th Floor Santa Ana A/NGIE ACEVEdc CA 92710 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (11OAL9n15 ACr1Rn HOW.. resunmad ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD