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GREELLC-03 EDOHERTY ,4coJRv' CERTIFICATE OF LIABILITY INSURANCE DATE312ri) �.� am019ota 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. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on •a., �,tt a J • [ i�4a� a. K �rn�-•� 4�,J�- /� n�.. �f ....n L. ....J..-n.........•/n\ PRODUCER 3lversifled Commercial Insurers - Lakewood 1074 South Alkire Street -skewood, CO 80228 INSURED GreenPlay LLC 1021 E. South Boulder Road Suite N Louisville, CO 80027 JEAICC. NLo, E.q: (303) 987.3373 AUDREss: john.ossian@dcinsurers.com INSURERISI AFFORDING COVERAGE INSURER A: The Hartford INSURER B : Pinnacol Assurance INSURERC: INSURER D: INSURER E: FAX 969-9120 NAIC 4 29424 41190 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. X COMMERCIAL GENERAL LU181LITY EACH OCCURRENCE S CLAIMS -MADE X OCCUR X X 34SBAIR6876 51112019 51112020 DAMAGE TO RENTED PREMISES(60 oa.00nc.) $ MED EXP (Any one parson( S PERSONAL & AM INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S � X POLICY Sea LOC PRODUCTS COMPIOPAGG S OTHER $ AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT (Ea amde l) $ X ANY AUTO X X 34UECJJ1390 51112019 511/2020 BODILY INJURY IPer peers.,) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Pe/ xc NI S WNE AUTOS AUTOS nIDAhiAGE $ ONLY ONL� lPa�aCCRZY S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 1 EXCESS LIAR CLAIMS MADE X 34SBAIR6876 5/112019 51112020 AGGREGATE $ DED X RETENTION$ 10,000 Gen Aggregate $ WORKERS COMPENSATION PER X OTH STATUTE [R AND EMPLOYERS' LIABILITY YIN X 4019301 511/2019 511/2020 ANY PROPRIETORIPARTNERIEXECUTIVE 8�ppFICERIMEMBER EXCLUDED/ N I A E L EACH ACCIDENT ; (MnndeWryIn NH) EL DISEASE - EA EMPLOYEE $ A Business Auto ded 34UECJJ1390 51112019 511/2020 comp 500 & toll. 500 SCRIPTION OF OPER TIONSILOCAMNS / VEHICLES 1ACORD 101, Addlll.nal Remarks Sch.d„l., may b. attached If m.r. space is mquU dl fficers y of Santa Ana, California and its o, officals, employees and agents are named as additional insured on the General liability (S800880405)on Primary J non-contributory basis (SS00080405) and commercial auto (HA99160312) and Umbrella policies, when required by written contract Waiver of subrogation the General flabitity(SS00080405), commercial auto (HA99160312), and workers compensation policies, when required by written contract 30 day icellation notice applies (IH0313061I), excess policy to follow form. 9 AR U ot0 City of Santa Ana, CA 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION. DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2016103) ®1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD