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<br />Ejhjubmmz!tjhofe!cz!Gsbodjof!S/!Wjmmbsfbm! <br />Gsbodjof!S/!Wjmmbsfbm <br />Ebuf;!3132/23/25!21;49;11!.19(11( <br />DATE (MM/DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE <br />12/06/2021 <br />THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER. <br />THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHE <br />POLICIESBELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S), <br />AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED, <br />subjecttothetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnot <br />confer rights to the certificate holder in lieu of such endorsement(s). <br />CONTACT <br />PRODUCER <br />NAME: <br />BIZINSURE LLC/PHS <br />FAX <br />(866) 467-8730(888) 443-6112 <br />PHONE <br />57102005 <br />(A/C, No): <br />(A/C, No, Ext): <br />The Hartford Business Service Center <br />E-MAIL <br />3600 Wiseman Blvd <br />ADDRESS: <br />San Antonio, TX 78251 <br />INSURER(S) AFFORDING COVERAGENAIC# <br />INSURED <br />INSURER A : <br /> Twin City Fire Insurance Company29459 <br />Hall Aquatic Life Support Designs DBA Hall Aquatic Design LLC <br />INSURER B : <br /> Hartford Accident and Indemnity Company22357 <br />347 GRANT ST SE <br />INSURER C : <br />ATLANTAGA30312-2226 <br />INSURER D: <br />INSURER E : <br />INSURER F : <br />COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: <br />THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD <br />INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS <br />CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHE <br />TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSRADDLSUBRPOLICY EFFPOLICY EXP <br />POLICY NUMBER <br />TYPE OF INSURANCELIMITS <br />LTRINSRWVD(MM/DD/YYYY)(MM/DD/Y YYY) <br />COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE <br />$2,000,000 <br />DAMAGE TO RENTED <br />CLAIMS-MADEOCCUR <br />$1,000,000 <br />X <br />PREMISES (Ea occurrence) <br />General Liability <br />$10,000 <br />MED EXP (Any one person) <br />X <br />PERSONAL & ADV INJURY <br />$2,000,000 <br />AX57 SBM BL252211/09/202111/09/2022 <br />$4,000,000 <br />GENERAL AGGREGATE <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRO- <br />POLICYLOC <br />$4,000,000 <br />PRODUCTS - COMP/OP AGG <br />X <br />JECT <br />OTHER: <br />COMBINED SINGLE LIMIT <br />AUTOMOBILE LIABILITY <br />$2,000,000 <br />(Ea accident) <br />ANY AUTO <br />BODILY INJURY (Per person) <br />ALL OWNEDSCHEDULED <br />BODILY INJURY (Per accident) <br />A57 SBM BL252211/09/202111/09/2022 <br />AUTOSAUTOS <br />HIREDNON-OWNEDPROPERTY DAMAGE <br />XX <br />AUTOSAUTOS(Per accident) <br />OCCUR <br />EACH OCCURRENCE <br />UMBRELLA LIAB <br />CLAIMS- <br />EXCESS LIAB <br />AGGREGATE <br />MADE <br />DED <br />RETENTION$ <br />WORKERS COMPENSATIONPEROTH- <br />X <br />AND EMPLOYERS' LIABILITYSTATUTE <br />ER <br />ANY <br />Y/N <br />$1,000,000 <br />E.L. EACH ACCIDENT <br />PROPRIETOR/PARTNER/EXECUTIVE <br />N/ A <br />57 WEC AC3MZN11/09/202111/09/2022 <br />B <br />$1,000,000 <br />E.L. DISEASE -EA EMPLOYEE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />E.L. DISEASE - POLICY LIMIT <br />If yes, describe under$1,000,000 <br />DESCRIPTION OF OPERATIONS below <br />$10,000 <br />Each Claim Limit <br />EMPLOYMENT PRACTICES <br />A57 SBM BL252211/09/202111/09/2022 <br />Aggregate Limit <br />$10,000 <br />LIABILITY <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES(ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Those usual to the Insured's Operations. Notice of Cancellation will be provided in accordance with Form WC990394, attached to this policy. Notice of <br />Cancellation will be provided in accordance with Form SS1223, attached to this policy. Certificate holder is an additional insured per the Business <br />Liability Coverage Form SS0008, attached to this policy. <br />CERTIFICATE HOLDERCANCELLATION <br />SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLED <br />City of Santa Ana <br />Jg!boz!pg!uif!bcpwf!qpmjdjft!bsf!dbodfmfe-!uijsuz!)41*!ebzt!qsjps!xsjuufo!opujdf!xjmm <br />BEFORETHEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVERED <br />Risk Management Division <br />cf!qspwjefe!up!uif!dfsujgjdbuf!ipmefs/ <br />IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />AUTHORIZED REPRESENTATIVE <br />SANTA ANA CA 92702 <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD <br /> <br />