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Digitally signed by Francine R. Francine R. Villareal Villareal ACORO® CERTIFICATE OF LIABILITY INSURANCE `� DATE(M4/202IYY) os/za/zozl 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 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 30 Burton Hills Blvd. PHONE (615) 665-9200 FAX (615) 665-9207 A/C No Exl: A/C, No: EMAIL certificates@robinsins.com ADDRESS: Suite 300 INSURER(S) AFFORDING COVERAGE NAIC # Nashville TN 37215 INSURER A: Crum d Foster 44520 INSURED INSURERS: AmGUARD Ins Co 42390 TruStar Energy LLC INSURER C : 10225 Philadelphia Ct INSURER D: INSURER E : Rancho Cucamonga CA 91730 INSURER F: COVERAGES CERTIFICATE NUMBER: June 2021 Master C0l REVISION NUMRFR- 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 rypE OF INSD WVD POLICY NUMBER ICY EFF MM/DD/YYYY POLICY EXP MMIODrvYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx7 OCCUR EACH OCCURRENCE $ 1.000,000 PREMISES Ea occu ante $ 1,000,000 X MEO EXP(Any one person) $ 5,000 Blanket Waiver of Subrogation X Blanket Additional Insured PERSONAL B ADV INJ URY $ 100,000 A EPK-135707 06/02/2021 06/02/2022 GEN- AGGREGATE U MIT APPLIES PER: PRO- POLICY [g PRO ❑ JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: PROFESSIONAL S 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 ANYAUTO BODILY INJURY (Per person) s BOWNED I SCHEDULED AUTOS ONLY AUTOS TRAU276306 06/02/2021 06/02/2022 BODILY INJURY (per accident) $ HIRED x NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGEAUTOS Peraccident Hired Auto Phys Dam $ 75,000 Hired Auto UMBRELLA LIAR X OCCUR EACH OCCURRENCE s 5,000,000 A 1X EXCESS LIAB X CLAIMS -MADE EFX-118052 06/02/2021 06/02/2022 AGGREGATE $ 5,000.000 DED I X RETENTION $ 101000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETORRARTNERJEXECUDVE OFFICERIMEMBER EXCLUDED? 71 NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory, in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below CONTRACTORS POLLUTION 8 EACH CLAIM $1,000,000 A ENVIRONMENTAL IMPAIRMENT EPK-135707 06/02/2021 06/0212022 AGGREGATE LIMIT $2,000,000 RETRO DATE 12/31/2012 DESCRIPTION OF OPERATIONS/ 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 written 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 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92702 / g, tc Rhk MougenedDmdm l!^i� r BENEUrED6APPRW�/®BYI: ©1988-2015 AC0R 9 ~a •Ac:e,: {^,yam )?, V:dWiGLG ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Risk Management Anatys[