W.A. RASIC CONSTRUCTION COMPANY, INC.

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Digitally signed by Francine R. Francine R. Villareal Villareal A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 6/30/2021 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 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 NAME: Commercial Associates Insurance PHOEFAX AICNNo, Ext: (714)524-4949 A/C NO; (714)524-4940 E-MAIL ADDRESS: 1594 N. Batavia Street INSURERS AFFORDING COVERAGE NAIC # Orange, CA 92867 INSURERA:Travelers Indemnity Co of CT 25682 INSURED INSURER B : INSURERC: W.A. Rasic Construction Co., Inc. INSURERD: 4150 Long Beach Blvd. INSURERE: Long Beach, CA 90807 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDDNYYY POLICY EXP MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A CLAIMS -MADE � OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 10,000 X DT22-Co-8670X247-TCT-21 5/1/2021 5/1/2022 PERSONAL & ADV INJURY $ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $ 4,000,000 POLICY PRO- JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 4,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 2,000,000 X BODILY INJURY (Per person) $ A ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS DT-810-8670X247-TCT-21 5/1/2021 5/1/2022 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIREDAUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DIED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMSER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Operations usual to the named insured - RFP No. 21-036 The City of Santa Ana, its officers, employees, agents, volunteers and representatives are added as additional insured including primary wording where required by written contract as respects general liability per attached CGD604 2/19 & CGT100 2/19. 30 days notice of cancellation except 10 days for non-payment. CERTIFICATE HOLDER CANCELLATION City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 ACORD 25 (2014/01) The ACORD name and logo are INS025 (201401) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Risk MmRig rnentDivision REVIEWED & APPROVED BY. - Risk Management Analyst