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ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) F 1 06111 /2019 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 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. 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 CONTACT Ashley Dunlap NAMEGovernor Insurance Agency, Inc. PPHCNN E (330)539-9999 ac Not (330)539-9998 972 Youngstown -Kingsville Rd. EMAIL adunlap@govemodns.com ADDRESS: P.O. BOX 770 INSURER(S) AFFORDING COVERAGE NAIC p Vienna OH 44473 INSURER A: R-T Specialty LLC INSURED INSURERS: Fiesta de Carnival INSURER C : 11278 Los Alamtos Blvd INSURER D : INSURER E : Los Alamitos CA 90720 INSURER F: COVERAGES CERTIFICATE NUMBER: CL196712203 RFVIRION MUMRFR- 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INSR LTR TYPE OF INSURANCE ADDIL INSD SUKK WVD POLICY NUMBER POLICY EFF MMIDDNYYY POLICY UP MM/DD LIMITS X COMMERCIALGENERALLIABILITY CLAIMS -MADE 7X OCCUR EACH OCCURRENCE 1,000,000 PREMISES Ea occurrence $ 100,000 MED UP (Any one erson) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 A Y VBA701224 05/27/2019 06/27/2020 GEN'LAGGREGATE LIMITAPPLIES PER: POLICY EC LOC GENERALAGGREGATE $ 2,000,000 PRODUCTS -COMPIOPAGG $ 2.000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMB Ea accident) $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE Peraccidenl $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN PER OTH- STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNERIEXECUTNE OFFICER/MEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101,AddiUonal Remarks Schedule, may be attached if more space is required) The City of Santa Ana, hs officers, employees, agents and volunteers are included as named as additional insured per the attached Blanket Additional Insured Form #GBA105004(06/14) with respect to the operations of the named insured. This coverage is primary without contribution on behalf of the additional Insureds. A 30 day notice of cancellation has been endorsed far the City of Santa Ana. REVIEWED & APPROVED By Risk MANAGEMENT U VWON CERTIFICATE HOLDER _ _ CANCELLATION MA;ML SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management _ AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza Santa Ana CA 92702 @ 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) — The ACORD name and logo are registered marks of ACORD