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A-2018-223-01 Francine R. a sIwflyaemaI,F,.�mn. Villareal wi.,Nl ire 2020oa.,7usos:13�rar CERTIFICATE OF LIABILITY INSURANCE DATE YYYY) 8/28/2021 8/17/207/2020 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. 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 endorsernal 1. PRODUCER Lockton Companies 444 W. 47th Street, Suite 900 Kansas City MO 64112-1906 (816) 960-9000 INSURED DUDEK 1475107 605 THIRD STREET ENCINITAS CA 92024 American Insurance Guarantee and COVERAGES CERTIFICATE NUMBER: 16765248 REVISION NUMBER: xxxxxxx 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. INSR LTR rypE OF ADDLSUBR SO WVO POLICY NUMBER POLICY EFF MM/DD POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR Y Y GL00146311 8/28/2020 8/28/2021 EACH OCCURRENCE $ 1000000 DAMAGE TO PREMISEScaaTED occurrence) $ 100000 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY ❑X JECT LOC PRODUCTS -COMP/OPAGG $ 2000.000 $ OTHER: A AUTOMOBILE LIABILITY y y BAP0146329 8/28/2020 8/28/2021 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per Pemon) $ XXXXXXX X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY P (Per accident ( ) $ XXXXX XX HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per eccldeni $ XXXXXXX $xxxxxxx C X UMBRELLA LIAB X OCCUR N Y AUC0146407 8/28/2020 9/28/2021 EACH OCCURRENCE $ 1.000.000 EXCESS LIAB CLAIMS -MADE AGGREGATE is 1,000,000 DED RETENTION$ $ xxxx xx A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? NIA y WC0146330 8/28/2020 8/28/2021 X SPER TATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS be. E.L. DISEASE -POLICY LIMIT $ 1000000 B PROFESSIONAL N N EEH591932835 8/28/2020 828/2021 PER CLAIM$1,000,000 LIABILITY AGGREGATE $2,000,000 INCLUDES POLLUTION DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 191. Additional Remarks Schedule, maybe attached U more.P.. 1. required) CITY OF SANTA ANA, OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE ADDITIONAL INSURED ON GENERAL AND AUTO LIABILITY COVERAGE ON A PRIMARY, NON-CONTRIBUTORY BASIS, AS REQUIRED BY WRITTEN CONRACT WAIVER OF SUBROGATION IN FAVOR OF THE ADDITIONAL INSURED APPLIES ON WORK COMP, GENERAL, AUTO AND UMBRELLA LIABILITY COVERAGE, AS REQUIRED BY WRITTEN CONTRACT AND WHERE ALLOWED BY LAW. COVERAGE IS SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. 16765248 CITY OF SANTA ANA RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLAZA SANTA ANA CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. .y1-Tejel:i Ixel ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD RLkMIDuuganen[Dtwim rrREVIEWED6{IA�PPR��c�w�EDBY}., rAHYM.i 1�. VM.W44L t �7 Risk Management Analyst