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Digitally signed A ACOORDr — D. T n IYYYY) CERTIFICATE OF LIABILITY INS A �Or-oF��2 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HO ER. THIS CERTIFICATE DO ' ,OTAFF,-MATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHEPOLICIES BELOW. THIS CERTIFICATE OFINSURANCE DOFt;�NJr11E/1)CO�I(Y�a}'p1rN�ttpEr[(6k1,/� C AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 1 CC VV CC ( l lJ L L �J` F IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. IfS1'BP JGATION IS �� rf conditions of the policy, certain policies may require an endorsement. Astatement anthis certificate does not confer rights tothe certificate hr.de' in lieu ofsucht=d eh sj) PRODUCER CONTACT NAME: Tina Jang PHONE FAX 1131 Howard Avenue (A/C, NO, EXT): 850-995-3499 (A/C, No): 650-376-5546 E-MAIL Burlingame CA 94010 ADDRESS: tjang@farmersagent.com INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: Truck Insurance Exchange 21709 INSURER B: Farmers Insurance Exchange 21652 170 DOGWOOD LN SOLUTIONS GROUP LLC 70 INSURERC: Mid Century Insurance Company 21687 INSURERD: INSURER E: VALLEJO CA 94591 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURAN CE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUB] ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDTL INSO SUBR FDOCYAWWOER WVD POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LMWS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE a OCCUR DAMAGE TO RENTED PREMISES (Ea Occurrence) $ 75,000 MED EXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 A Y N 604713332 03/19/2022 03/19/2023 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ PROJECT ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,00 OTH ER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY(Per person) $ v� ANYAUTO BODI LY INJURY (Per accident) $ A OWNEDAUTOS SCHEDULED ONLY AUTOS Y 604713332 03/19/2022 03/19/2023 PROPERTY DAMAGE (Per accident) $ HIREDAUTOS X NON -OWNED ONLY AUTOSONLY UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER STATUTE TOT HER $ E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/ Y/N EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A E.L. DISEASE - EA EMP LOYE E E.L. DISEASE -POLICY LIMIT If yes, describe under DESCRIPTION OF ffA5K7ri5bw DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If mare space is required) City of Santa Ana, its officers, employees, agents and representatives are Additional Insureds with respect to General and Auto Liability per the attached endorsements as required by written contract. Insurance is Primary and Non -Contributory. 30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions. Agreement Number (N-2021-106) CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Risk Management Division DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE,WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Tina Jang Risk kluagementDMsian +� \@ REVIEWED & APPROVED BY: ACORD 25 (2016/03) @ 1988-2015 ACOR t 31-1769 11-15 TheACORD nameand logoare registered marks ofACORD Ifl5K Management Specialist