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Samantha Digeally signed by Samantha signed M. Lambert 10. g;6-0ao0' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDTYYY) 10/22/2021 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 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 Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA 5 Concourse Parkway Suite 2150 CONTACT PHONE FAX e n Le 1 (888) 202-3007 AIC Na AOOREss: COnt,CtghI" x.Com INSURERS AFFORDING COVERAGE NAICN Atlanta GA, 30328 INSURERA: Hiscox Insurance Company Inc 10200 INSURED Department of Civic Things INSURER B: INSURER C : 198 Cazneau Ave INSURER D: Unit B Sausalito CA 94965 INSURER E: INSURER F : COVERAGES ULKI IFICA IE NUMRFR- ocsncrnst str ussss. 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. HER LTR TYPE OF INSURANCE ADDL INSD SUBS O POLICY NUMBER MWDD EFF MM/D�IYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 CIAIMS-MADE 1K AMAGETO E TIED OCCUR PREMISES Eaoceurrence $ 100,000 MED EXP (Any one person) $ 5,000 Primary &Non Contributory PERSONALSADVINJURY $ 1,000,000 A X Y UDC-4856692-CGL-21 06/01/2021 06/01/2022 AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 GENT X POLICY ECT LOC PRODUCTS-COMP/OP AGG $ SIT Gen. Agg. OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Peraccident) S AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE S Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE I ER E.L. EACH ACCIDENT $ ANVPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDEDT NIA E.L DISEASE -EA EMPLOYE $ (Mandatory In NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of Santa Ana its employees directors, officers, assigns, parents and subsidiaries are additional insured per the terms and conditions of the general liability policy. City of Santa Ana, Risk Management 20 Civic Center Plaza SHOULD ANY OF THE ABOVE DESCRIB +^' a RldtMaegenadDbhimr Santa Ana, CA 92701 THE EXPIRATION DATE THEREOF, '< REVIEWED&APPROVEDBY.- ACCORDANCE WITH THE POLICY PROV '; !�Iioeiidi Wdw r Risk Maragement Supervisor AUTHORIZED REPRESENTATIVE I _� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD