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A` Rb® CERTIFICATE OF LIABILITY INSURANCE DATE( M/2D2) 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 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 Champion Risk & Insurance Services, L.P. 12250 El Camino Real, Ste 375 CONTACT NAME: FAX 8583897900 A/c No: nAIL DDRe s: certsonly@championrisk.net LICENSE# OH18156 San Diego CA 92130 INSURERS AFFORDING COVERAGE NAIL# INSURER A: Insurance Company of the West 27847 INSURED SURGE-3 INSURER B : Inland Moving & Storage Co DBA Burgess Moving and Storage INSURER C: INSURER D P.O. BOX 28 Riverside CA 92502 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 1471031158 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 INSURANCEJM2 ADDLSUBR POLICY NUMBER POLICY EFF MMIDDIIYYYY POLICY EXP MOLICY EXIP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS -MADE OCCUR PREMISES Ea oocunence $ MED EXP(My one person) $ PERSONAL & AOV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: POLICY 0 PEO LOC GENERALAGGREGATE $ PRODUCTS - COMPIOP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS Per accident BODILY INJURY ( ) $ NON -OWNED HIRED AUTOS AUTOS PROPERTYDAMAGE Per accitl n $ 8 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WSD5G3405604 7/1/2020 7/1/2021 X TSPTEARTUTE I I OERH E. L EACH ACCIDENT $1.000.000 ANY PROPRIETORIPARTNEWEXECUTIVE CFFICERIMEMBER EXCLUDED? NIA E.L. DISEASE -EA EMPLOYEE $1,0D0,00D (Mandatory In NH) If yes, describe under EL DISEASE -POLICY LIMIT $1,0D0,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City shall be excess and noncontributory. City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD C ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD i RWeMnugemenfDMelon yi ccREVIEWE06pDAPPR1O'VI®aYl: ment Analyv Risk Manage00