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rrdiricine n. Digitally signed by tranane N. Villareal ® Villareal Date: 2021.06,14 16:42:51 -07'00' ACC)RCERTIFICATE OF LIABILITY INSURANCE °"o6V0712021 THIS CERTIFICATE Is ISSUED AS AMATTER OF INFORMATION ONLY ANDCONFERS NO RIGHTS UPON THECERTIFICATE HOLDER. THISCERTIFICATE DOES NOTAFNRMATIVELYOR NEGATIVELY AMEND, EXTEND ORALTERTHE COVERAGE AFFORDED BYTHE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOTCONSTITUTE ACONTRACT BErWEENTHE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, ANDTHE CERTIFICATE HOLDER. IMPORTANT. IftheceRietate halderis an ADDITIONALINSURED, the Policy(les) must have ADDITIONAL INSURED provisions or be endorsed. if SUBROGATION IS WAIVED, subjecttothe terms and conditiomof the policy, certain policies may require anendorsement. Astatementon thlsoerti6tatedoes notmnferrights to thecenifmte holder in lieu ofsuch endorsement(&). PRODUCER CONTACT NAME: Tina Jang 1131 Howard Avenue PHONE FAx (A/c, No, EXT): 650-995-3499 (a/c, No): 650-37fi-5546 Burlingame CA 94010 E-AW L ADDRESS: tjang@farmersagent.com INSURER(S)AFFORDING COVERAGE NAIL# INSURED 170 SOLUTIONS GROUP LLC 170 DOGWOOD LN VALLEJO CA 94591 INSURERA: Tnrck Insurance Exchange 21709 INSURER B: Farmers Insurance Exchange 21652 INSURERC: Mid Century Insurance Company 21687 INSURER D: INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISIONNUMBER: THIS 15 TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMEABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINGANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUEDTR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIMS. INSR LTR TYPEOFINSURANCE ADOTL INSO 91BR WVD POLICYNUMBER POLICY FEE (MM/DD/YYYY) POLICY EXP (MM/DD/YYVY) LIMITS COMMERCIAL GENERAL LABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS.MADE OCCUR DAMAGETORENTED PREMISES (Ea Occurrence) § 75,00 MEDEXP(Anyoneperson) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 A Y N 604713332 03/19/2021 03/19/2022 GEN'L AGGREGATE LIMIT APPLIESPER: X POLICY ❑ PROJECT ❑ LOC GENERALAGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2.000,000 OTHER: $ AUTOMOBILELIABILITY COMBINED SINGLE LIMIT (EaacddenU $ 1,000,00 ANYAUTO BODILY INJURY (Per Person) $ A OWNEDAUTOS SCHEDULED ONLY AUTOS Y 604713332 03/19/2021 03/19/2022 BODILY IN JURY(Peracddent) $ X HIREDAUTOS INON-OWNED ONLY ALITOSONLY PROPERTY DAMAGE (Per accident) $ $ OCCUR EACH OCCURRENCE $ AGGREGATE § EXCESS LIAB CLAIMS -MADE DED RETENTION$ § -4UMBRELLAUAB WORKERSCOMPENSAT10N AND EMPLOYERS'LIABILITY STATUTE OTHER $ ANY PROPRIETOR/PARTNER/ Y/N EXECUTIVE OFFICER/MEMBER N/A E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE EXCLUDED] (Mandatary in NH) Ifyes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPDON OFOPERATIONS/LOCATIONS/VEHICLES(ACORD 101, Additional Remarks Schedule, may beattached If more 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 "r w. """ "" SHOULDANY OF THE 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 Aard, Ana CIA 92702 Rmk Men%vA dDividen s` REAEwED 6 APPROVED Sill ACORD25(2016/03) ©1988-2015ACOR 31-1769 11-15 The ACORD name and logo are registered marks of ACORD ® Risk Management Analyst