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Digitally signed by Francine R. Francine R. Villareal Villareal A� a CERTIFICATE OF LIABILITY INSURANCE dnr812412021 l oa/za/zo21 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 CONTACT NAME: Robins Insurance Agency, Inc PHONE (615) 665-9200 FAX (615 665-9207 ) AIC No Ext: AIC, No: 30 Burton Hills Blvd. certificates@robinsins.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC If Suite 300 INSURERA: Crum & Foster 44520 Nashville TN 37215 INSURED INSURER B: AmGUARD Ins CO 42390 TruStar Energy LLC INSURER C 10225 Philadelphia Cl INSURER D : INSURER E Rancho Cucamonga CA 91730 INSURER F: COVERAGES CERTIFICATE NUMBER: June 2021 Master COI 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 rypE OF INSD MD POLICY NUMBER POLICY EFF MMIDDIYYYY P LI YEXP M DDNYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR I, IcU PREMISES Ea ary $ 1,000,000 X MED EXP (An one person) $ 5,000 Blanket Waiver of Subrogation X Blanket Additional Insured PERSONAL B AOV INJURY $ 100,000 A EPK-135707 06/02/2021 06/02/2022 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY [g JECOT PR ❑ LOC PRODUCTS - COMPIOP AGG $ 2,000,000 OTHER: PROFESSIONAL $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea aaidmt $ 1,000,000 X BODILY INJURY (Par person) S ANYAUTO B OWNED SCHEDULED AUTOS ONLY AUTOS TRAU276306 06/02/2021 06/02/2022 BODILYINJURY(Par accident) $ X PROPERTY DAMAGE Per accident S HIRED H NON -OWNED AUTOS ONLY AUTOS ONLY X Hired Auto Phys Dam s 75.000 Hired Auto X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 A EXCESSUAB CLAIMS -MADE EFX-118052 06/02/2021 06/02/2022 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN I PER OTH- STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNERIEXECUTIVE El OFFICER/MEMBER EXCLUDED? NIA E.L. DISEASE -EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT $ CONTRACTORS POLLUTION & EACH CLAIM $1,000.000 A ENVIRONMENTAL IMPAIRMENT EPK-135707 Ofi/02/2021 06/02/2022 AGGREGATE LIMIT $2,000,000 RETRO DATE 12/31/2012 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The certificate holder, its officers, officials, employees and volunteers are named as additional insured with respects to the general liability where required by whiten contract. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza p Santa Ana CA 92702 /li_ e'�'^= =M� fsrY \i REVIEWED Fr APPROV®BY: 01988.2015 ACOR F4M,r„y,e ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD (�'' Risk Management Analyst