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<br />ACORa CERTIFICATE OF LI
<br />DATE(MMIDDIYYYY)
<br />IL'19AASUPV En ie Aceved
<br />L� 9
<br />08/02/2022
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON AffWWff�� N S r' G �1 14 ATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN (T�ID T E J�F.,Q,�j� D BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTI T iiCC Z�R}}N T t EE 1 0•}INbdRER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME: Carlo Narduzzl, Branch Mana in Partner
<br />Basin Pacific Insurance & Benefits
<br />PHONE 509-470-6000 a Not- 509 470-6272
<br />E-MAIL cnarduzzi@basinpacific.com
<br />ADDRESS:
<br />1025 S. Pioneer Way
<br />INSURERS AFFORDINGCOVERAGE
<br />NAICR
<br />Moses Lake, WA 98837
<br />INSURERA: Valley Fore Insurance Company
<br />20508
<br />INSURED
<br />Airstreams Renewables, Inc.
<br />785 Tucker Rd, Suite G-603
<br />INSURER B: Continental Casualty
<br />20443
<br />INSURER C: Homesite Insurance Company
<br />17221
<br />INSURERD: State CompensationInsurance Fund
<br />Tehachapi, CA 93561
<br />INSURER E:
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />JUM
<br />MD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDD
<br />LIMITS
<br />A
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />6057171294
<br />OS/Oi/2022
<br />OS/O1/2023
<br />URRENCE
<br />$ 1,000,000
<br />O RE ED
<br />Ee occurrence
<br />100,000
<br />$Any
<br />one arson)
<br />$ 15,000&ADV
<br />INJURY
<br />M
<br />$ 1,000,000GEN'L
<br />AGGREGATE LIMIT APPLI ES PER:
<br />PRO- LOC
<br />GGREGATE
<br />$ 2,000,000POLICY
<br />-COMPIOPAGG
<br />$ 2,000,000ECTOTHER:
<br />$B
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />6057171702
<br />05/01/2022
<br />05/01/2023ISINGLE
<br />LIMIT
<br />$1,000,000
<br />BODILY INJURY (Per Person)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />1AUTOS
<br />Per accitlen
<br />( BODILY INJURY t)
<br />$
<br />HIRED NON -OWNED
<br />ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />Medical Payments
<br />$ 5,000
<br />C
<br />UMBRELLAUAB
<br />EXCESS LIAR
<br />OCCUR
<br />CLAIMS -MADE
<br />CXP- 005213-00
<br />05/01/2022
<br />05/01/2023
<br />EACH OCCURRENCE
<br />AGGREGATE
<br />$5,000,000
<br />$ 5,000,000
<br />X
<br />OED I I RETENTION$
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERIMEMBEREXCLUDEDY
<br />MIA
<br />9069628-22
<br />08/28/2022
<br />08/28/2023
<br />PER OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS beow l
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />The City of Santa Ana, its officers, officials, employees, agents, volunteers and representatives are included as an Additional
<br />Insured. Such insurance as is afforded and shall be primary, and any insurance carried by City shall be excess and
<br />noncontributory. Thirty (30) day prior written notice of cancellation will be provided to certificate holder.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORD:ED REPRESENTATIVE
<br />©1988-2015 ACI
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of AC IRD
<br />a, .. �,il,
<br />RiukMancgemedDhdselml
<br />REVIEWED&APPRovacar
<br />A4U Aewedo
<br />-
<br />Risk Management Specialist
<br />
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