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Digitally signed by Francine R. Francine R.Villareal Villareal ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD YYYY) 08/24/2021 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 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. PARONFE Eat _ (615) 565-9200 q1c, No : (615) 665-9207 EMAIL certificates@robinsins.com ADDRESS: Suite 300 INSURER(S) AFFORDING COVERAGE NAIL# Nashville TN 37215 INSURER A: Crum & Foster 44520 INSURED INSURER B: AmGUARD Ins Co 42390 TruStar Energy LLC INSURER C 10225 Philadelphia Cl INSURER 0: NSURER E: Rancho Cucamonga CA 91730 INSURER F: COVERAGES CERTIFICATE NUMBER: June zuzl Master COl RFVIRION NIIMFl 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 ADOL INED SUBIR Me POLICYNUMBER POLICY EFF MMIDDrYYYY POLICY EXP MMIDDIYYYY LIMITS X COMMERCIAL GENERALLIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ 1.000,000 PREMISES Ea occurrence $ 1,000,000 X MED EXP(Any oneperson) $ 5.000 Blanket Waiver of Subrogation Blanket Additional Insured PERSONAL&ADV INJURY g 100,000 A X EPK-135707 06/0212021 06/0212022 AGGREGATE LIMITAPPLIES PER: POLICY [g PRO ❑ LOC JECT GENERALAGGREGATE g 2,000,000 GEN'L PRODUCTS-COMPIOPAGG $ 2,000,000 PROFESSIONAL s 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) S B OWNED SCHEDULED AUTOS ONLY AUTOS TRAU276306 06/02/2021 06/02/2022 BODILY INJURY Peraccidenb $ HIRED NO&OWNED AUTOS ONLY HAUTOS ONLY X PROPERTY DAMAGE Per accident $ X Hired Auto Phys Dam s 75,000 Hired Auto X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 AGGREGATE $ 5,000,000 A EXCESS LIAB X1 CLAIMS -MADE EFX-118052 O6/02/2021 06/02/2022 DED I X1 RETENTION S 10.000 S WORKERS COMPENSATION YIN ANY PROPRIETORIPARTNETEXECUTIVE ❑ OFFICEWMEMBER EXCLUDED? NIA PERT STATUTE ER E.L. EACHACCIDENT 5 E L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) Ifyes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below CONTRACTORS POLLUTION & EACH CLAIM $1.000,000 A ENVIRONMENTAL IMPAIRMENT EPK-135707 06/02/2021 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 written contract. City of Santa Ana Risk Management Division 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 /z @ 1988-2015 ACORD ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Rlsk Mnugenwlt Division \c ram ((R�EVIEWED& pAPPRO�V�ED Br rArlhrtii�Z R. V�f,WPFL ® Risk Management Analyst