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Digitally signed by Francine R. Francine R. Villareal Villareal ,4cvo CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/26/2021 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 endorsement(s). PRODUCER CONTACT NAME: Erika Sokolik Arthur J. Gallagher & Co. PHONE FAx Insurance Brokers of CA Inc. LIC #0726293 AIC No Ext: 818-534-3558 A/C No: 818-316-0990 ADODRESS: Erika_Sokolik@ajg.com 21820 Burbank Blvd. Suite 175 INSURER(S) AFFORDING COVERAGE NAIC# Woodland Hills CA 91367 INSURER A: West American Insurance Company 44393 INSURED INSURER B: Insurance Company of the West 27847 Downey Vendors, Inc. DBA: Premier VendGroup INSURER C: Travelers Property Casualty Co of America 25674 INSURERD: 6814 Suva Street Bell Gardens CA 90201 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER:286429888 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y BKVV56585014 4/1/2021 4/1/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED ccurrence PREMISES Ea occurrence) $ 100,000 VIED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY ❑ LOC JECT X PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY C X UMBRELLA LAB X OCCUR ZUP16N7899421NF 4/1/2021 4/1/2022 EACH OCCURRENCE $10,000,000 AGGREGATE $ 10,000,000 EXCESS LAB CLAIMS -MADE DED X RETENTION $ 1 n nnn $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WVE503733306 7/26/2021 7/26/2022 X PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 /ME OFFICERMBER EXCLUDED? ❑ NIA E.L. DISEASE- EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of Santa Ana is named Additional Insured with respects to General Liability coverage per attached form CG 8810 0413. 30 days Notice of Cancellation Applies. CERTIFICATE HOLDER CANCELLATION 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 Division 20 Civic Center Plaza, 4th floor AUTHORIZED REPRESENTATIVE Santa Ana CA 92702 y µoRa„�F RiskMaagmierdDivision 1 o REVIEWED & APPROVED BY.- ©1988-2015 ACORD C ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Risk Management Analyst