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Tori Pierson oate.20 043713:16:3-0TN' �►� o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDMYY) oa/zo/zoz2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 CONTACT Shelby Cecena AFIS NAME: James G Parker Insurance Assoc PHONE (559) 58 -3323 FAX (559) 584-9313 A/C No EKt: AIC, No: Become Ins Agency Lic#0554959 E-MAIL shelbyc@jgparkeccom ADDRESS: P O BOX 1129 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Landmark American Ins Co 33138 Hanford CA 93232 INSURED INSURER B: California Automobile Insurance 38342 Baker Rescue Services Inc INSURER C: State Compensation Ins Fund 35076. 19744 Beach Blvd #366 INSURER D: INSURER E : Huntington Beach CA 92648-2988 INSURERF: COVERAGES CERTIFICATE NUMBER: 21-22 Master GL/BA/EX/ REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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 ADOLSUBRPOLICY INSD MD POLICY NUMBER EFF MWDD/YYYY P E P MMIDDIYYYY LIMITS MERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000CLAIMS-MODE �OCCUR T PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 5,000 I PERSONAL aADV INJURY $ 1,000.000 A Y LHC843766 08/03/2021 08/03/2022 GENL AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 X POLICY JECPROT LOC PRODUCTS - COMPIOP AGG $ 2,000,000 OTHER: CGL B Professional Lett $ 2,01101 AUTOMOBILE LIABILITY EBMBNYL+PUINGLE LIMIT Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ ANYAUTO B OWNED F SCHEDULED AUTOS ONLY AUTOS Y BA040000069059 08/03/2021 08/03/2022 BODILY INJURY (Per accident) $ HIRED I I NON -OWNED AUTOS ONLY ALMOS ONLY PROPERTY DAMAGE Per accitlent $ Uninsured motorist s 1.000,000 UMBRELLA LIAB OCCUR """"""""""""""' EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS -MADE LHA252201 08/03/2021 08/03/2022 AGGREGATE $ 5,000,000 DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPXCLUD (EXECUTIVE 1 (Mandy, WMEMBEft EXCLUDED? IMandatsc in NH)))) NIA Y 1851446-2021 09/01/2021 09/01/2022 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 Dyes,RIPTIONribe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of Santa Ana, officers, agents, employees, and volunteers are included as Additional Insured with respects to General Liability per attached form RSG95001 0903 and Automobile Liability per attached form MCA8510 0817. Primary & Non-contributory is included with respects to General Liability per attached form RSG54155 0816. Wavier of Subrogation Applies per form 10217 REV.7-2014. 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 AUTHORIZED REPRESENTATIVE „ Wi Mo�gutnl OhYm 20 Civic Center Plaza, 4th flo .f 96,"•.q�&N®�, Santa Ana CA 92701 (� D n -/pu � ^/ ✓� tL irwen 91988-2015ACORD ..__.._.._r_.._... _,,..a.._.._ ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD