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CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDCNYYYY) 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 WANED, 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 Bolton & Company NAMNT E: CT 3475 E. Foothill Blvd., Suite 100 PHONE -- FAX — Pasadena, CA 91107 ELMAIL EaD. szsl 7ssa000INC.Nal: 6(_21� 583-2117 ADDRESS DDRESB: _ INSURERS) AFFORDING COVERAGE NAICN —_ 1 —. _._ wwW.bollpnco.com 0008309 INSURER A: Greenwich Insurance Company I 22322- INSURED INSURER B: XL Insurance America Inc. _ _ 24554 United Storm Water, Inc. INSURER C: XL Specialty Insurance Cam an 37865 14000 East Valley Blvd.ra �� City Of Industry CA 91746 INSURERD: Indian Harbor Insurance Company 36940 INSURER E COVERAGES CERTIFICATE NUMBER- RunRino RFVISIr1N NIIMRFR- 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. INTRR T PEOFINSURANCE ADOUSUBP - POLICY EFF man WyD, POLICY NUMBER MIDDrYYYY POLICY UP MMIpDIYYYY LIMBS A ✓ .COMMERCIAL GENERAL 4ABILITY ✓ GEC3OO1234 12/3112Oi9 1273112020._ FACH OCCURRENCE 51,000000 CIAIMSdMDE OCCUR _-✓ tiA GE ThA O NO NTE� -- PREMISES (Fa mcunei,ca. 1$1 W O00 MED UP(Myone Personl SS000 PERSONAL & AM INJURY $1 000,000 GEN'L AGGREGATE LIMIT APPLIES PER - GENERAL AGGREGATE s2,000,000 POLICYOTHER LJ JEGT _ J LI PRODUCTS - COMPIOP AGO 82,000,000 _ OTHER'. � �$ B AUTOMOBILE LIABILITY AECO0489381 AECO048939 11 12/31/2019 12)31/2020 COMBINED SINGLE LIMIT $ 1 000 000 D ANY AUTO &a emdean _ I BODILY INJURY (Pe pareonl I S OWNED SCHEDULED AUTOS ONLY AUTOS --- BODILY INJURY IPw amaenl) $ HIRED NON -OWNED AUTOS ONLY ✓ AUTOS ONLY PROPERTY DAMAGE - 5- _Ler emdi mq $— C UMBRELLAUAS V OCCUR UECO048W 12/31/2019 12/31/2020 EACH OCCURRENCE I$16,_000000 ✓ E%CE53 LAB CLAIMS -MADE __I..._�— _ .. AGGREGATE _ _ $1 S_ggO OOO, I DED i ✓ RETENTION510.000 _ Is C WORKERS COMPENSATION WEC3001235 12/3112019 12/31/2020 PER OTH- ANDEMPLOYERS 'LIABILITY YIN _✓. STATUTE ER _ ANYPROPRIETOWPARTNEWEXECUTIVE NIA EL EACH ACCIDENT S1 OFFICERIMEMBEREXCLUDED> pAandalary In RIO ------- _OOO,oOO EL DISEASE EA EMPLOYE Ir Yee. d.s umle,— DESCRIPTIONOFOPERATIONSeelow E.L. DISEASE -POLICY LIMIT S1000000 D Pollution Liability PECO048963 12131/2019 12/31/2020 $15,000.000 Each Claim 1$25,006 Ded. D Professional Liab - Claims Made PECO048963 12/31/2019 12/31/2020 $15.000.000 Each Claim / $25.000 Ded. DESCRIPTON OFOPEMnONS ILOCAMN51 VEHICLES (ACORD Un, AdtllUonal Remarks SCNduls, may W aeachad if momspace is squired) GL Additional Insured applies per CG20100413 & CG20370413 attached. only if required by written contractlagreement GL Primary & Non -Contributory Wording applies per XIL4240605 attached. Re: Agreement #A-2017-157 in City of Santa Ana. Excess Policy follows form. Additional Insured(s): City of Santa Ana, its officers. agents. volunteers and employees. CERTIFICATE HOLDER CANCELLATION Re: Agreement #A-2017-157 City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATION DATE THEREOF, NOTICE WILL BE Risk Management Division THE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana, CA 92702 RE WED & APPROVED REPRESENTATNE By Ri MANAGEMENT DivisiON AUTHORIZEp —1�/N/pry{VJ^7L Cassandra Rosales J�" VO LULU ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) I ACORD name and logo are registered marks of ACORD SJIa8 J9 1 ON tP'M u: I :3 2-, Ail Llnep sA AIT.+tAM,.J WI3F+RT :M F..a 11— L