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Francine R. nalmw,ene bynnan+k w"-' Villareal--°.,b, I so ACOR" CERTIFICATE OF LIABILITY INSURANCE �i 8/1/2021 DATE(MMIODNYYY) 11/11/20 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 endomement(s). PRODUCER Lockton Companies 444 W. 47th Street, Suite 900 Kansas City MO 64112-1906 (816) 960-9000 CONTACT PHONE N E weNo E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: LibeM Insurance Co oration 42404 INSURED WACHTER, INC. 6969 16001 WEST 99TH STREET INSURER B: Employers Insurance Company of Wausau 21458 INSURER C: LENEXA KS 66219 INSURER D INSURER E: INSURER F: COVERAGES a CERTIFICATE NUMRFR- 1 A71171 R RStIMnM MnM9ER 111— 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. INTR TYPE OF INSURANCE Arid INSD BOBR MD POLICY NUMBER POLICY EFF MMIDDNYYY) POLICY EXP (MMuDDNYYYJ LIMITS A X COMMERCIAL GENERALLABILDY CLAIMa-MADE OCCUR Y N TB7-69IA72101-020 8/1/2020 8/1/2021 EACH OCCURRENCE $ 2000000 PREMISES Ea occurrence) $ 300000 MED EXP (An one person) $ $ 000 PERSONAL S ADV INJURY $ 2,000,000 AGGREGATE LIMIT APPLIES PER: POLICY � JECT LOC GENERALAGGREGATE $4000000 GEN'L PRODUCTS -COMP/OPAGG $ 4,000,000 $ OTHER: A AUTOMOBILELIABILITY Y N AS7-691472101-010 8/l/2020 8/1/2021 COMaBINEDSINGLE LIMITEa $ 3000000 X ANY AUTO OWNED SCHEDULED AUTOS ONLYHAUTOS HIRED ON -OWNED AUTOS ONLYAUTOS ONLY BODILY INJURY (Per person) $,ii{�{XXiiX X BODILY INJURY(Peraccident) $ PROPERTY DA$ Peraccident �.X��.�� Corms/Coll Deds. Is 5,000 PHYS DAM A UMBRELLA LIAB X OCCUR N N TH7-691-472101-040 8/1/2020 8/l/2021 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 X EXCESS LAB CLAIMS -MADE DED I I RETENTION$ $ XXXXXXX B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? N (Mandatory in NH) Ryes, describe under under NIA NPER WCC-691-472101-030 [EXCL. ND, OH, WY, & WA] 8/1/2020 8/1/2020 8/1/2021 8/1/2021 X STATUTE ER 'ER E.L. EACH ACCIDENT $ ] OOO OOO E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS bebw DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached R more space is msuired) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERlas) REFERENCED. FOR CANCELLATION FOR ANY REASON OTHER THAN NONPAYMENT OF PREMIUM, THE INSURER(S) WILL SEND 30 DAYS NOTICE OF CANCELLATION TO THE CERTIFICATE HOLDER, CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES IS/ARE ADDITIONAL INSURED(S) ON A PRIMARY AND NON-CONTRIBUTORY COVERAGE BASIS AS RESPECTS LIABILITY COVERAGE FOR THIS PROJECT. INSURANCE SHOWN APPLIES ONLY TO EXTENT OF WRITTEN CONTRACT. 14711718 CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RISK MANAGEMENT DIVISION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 CIVIC CENTER PLAZA ACCORDANCE WITH THE POLICY PROVISIONS. 4TH FLOOR SANTA ANA CA 92701 AUTHORIZED REPRESENTATIV . 21 �,�es.,:: w#k DMellm REVIEWED & APPROVEDBY: 91988 015 ACORD C ?h . l '"PP� ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD I� Risk Management Analyst