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DATE (MM/DD/YYYY) •y- — �y CERTIFICATE OF LIABILITY INSURANCE Acct#:2807366 09/02/2021 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 LOCKTON AFFINITY, LLC CONTACT NAME: LOCKTON AFFINITY, LLC PHONE FAX P.O. BOX 879610 (A/C, No, Ext): 888-828-8365 (A/C, No): 913-052-7599 ADDRESS: KANSAS CITY, MO 64187-9610 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B : Cannon Corporation 1050 Southwood Dr INSURER C : INSURER D: San Luis Obispo, CA 93401-5813 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE IANSD SWVDR POLICY NUMBER POLICY EFF) (M POLICY YYYY ( POLICY EXP ) POLICY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _7RENTED DAMAGE CLAIMS- OCCUR PREM SESOEa occurrrence $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $ POLICY RO- LOC P D.IFC:T PRODUCTS - COMP/OP AGG $ OTHER: A AUTOMOBILE LIABILITY X X L315536-21 09/01/2021 09/01/2022 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE 'per a.,dent) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS' LIABILITY Y/N STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) If yes, describe under E.L. DISEASE- EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GPBR: 2FL5 POLICY PROVIDES PROTECTION FORANYAND ALL OPERATIONS/JOBS PERFORMED BY THE NAMED INSURED WHERE REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDERIS AN ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT. WAIVER OF SUBROGATION INCLUDED BY WRITTEN CONTRACT. INSURANCE IS PRIMARY AND NON-CONTRIBUTORY.City of Santa Ana, its officers, agents and representatives are Additional Insureds withrespect to Auto Liability as required by written contract. Insurance is Primary and Non -Contributory. 30Days' Notice of Cancellation with 10 Days' Notice for Non -Payment of Premium in accordance withpolicy provisions. Project#A2019-1174-03. Cannon #190815. City of Santa Ana Risk Management Division, 4th Floor 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. AUTHORIZED REPRESENTATIVE Rielt:lferd8erneni Division HEAEwm & APPROVED BY: °cam_ '7o © 1988-2016 ACORC u— Rik ManegementCleriralAide ed. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD