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equally 9Ened by Tod Pierson <br />P Tori erson Dare: 2012.03.0915DA03 <br />02,00, <br />�1 ® <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DDIYYYY) <br />12/28/2021 <br />1 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If <br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Ann Risk services South, Inc. <br />Msc# 17691INC, <br />CONTACT <br />AME: <br />NPHONE <br />No. Erg: (664) 241-1510 NL. No.: (864) 241-I511 <br />EMAIL <br />ADDRESS; <br />Po Box 551343 <br />Atlanta GA 30355 USA <br />INSU RER(S) AFFORDING COVERAGE <br />NAIC9 <br />INSURED <br />INSURERA: National Fire Ins. Co, of Hartford <br />20478 <br />Grant Thornton LLP <br />171 North Clark street <br />INSURER B: The Continental Insurance Company <br />35289 <br />INSURERC: <br />Suite 200 <br />Chicago IL 60601 USA <br />INSURER D: <br />INSURER E: <br />INSURER P. <br />COVERAGES CERTIFICATE NUMBER: 570090873716 REVISION NUMBER: <br />THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested <br />LTR <br />TYPE OF INSURANCE <br />INSD <br />WVDPOUCYNUMBER <br />MMIDDIYYn <br />FOLC <br />LIMITS <br />-77 <br />X <br />COMMERCIAL GENERAL LIM LITY <br />CLAIMS -MADE MOCCUR <br />7 <br />General Liability <br />EACHOCCURRENCE <br />$1,000,000 <br />PREMISES Ea occurrence <br />$1,000,000 <br />MED EXP(Any me person) <br />$15,000 <br />PERSONAL a ADV INJURY <br />$1,000,000 <br />GEN'LAGGREGATE LIMITAPPLIES PER <br />GENERALAGGREGATE <br />$2,000,000 <br />POLICY ❑ PRO ❑X LOC <br />JECT <br />PRODUCTS -CONFIDE AGG <br />$2, DOD, WO <br />OTHER: <br />A <br />AUTOMOBILE LIABILITY <br />6081373210 <br />Auto <br />07/31/202107/31/2022 <br />COMBINED SINGLE LIMIT <br />Eaacclders <br />$1,000,000 <br />BODILY INJURY (Par person) <br />ANY AUTO <br />BODILY INJURY (Peraccitlen0 <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />X HIRED AUTOS Ix NON -OWNED <br />ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />PeraccitleM <br />B <br />X <br />UMBRELLALIAB <br />EXCESS LIAS <br />X <br />OCCUR <br />CLAIMS -MADE <br />6081347562. <br />Umbrella <br />07/31/2021 <br />07/31/2022 <br />EACH OCCURRENCE <br />$5,000,000 <br />AGGREGATE <br />$5,000,000 <br />OED <br />RETENTION <br />WORKERS COMPENSATION AND <br />PER STATUTE <br />EMPLOYERS LIABILITY YIN <br />ANY PROPRIETOR I PARTNER I EXECUTIVE <br />E.L. EACH ACCIDENT <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />NIA <br />E.L. DISEASE -EA EMPLOYEE <br />If yes, dowrino under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required) <br />City of Santa Ana, its officers, officials, employees, and volunteers is added as Additional Insured as respects the General <br />Liability and Automobile Liability as required per written contract. umbrella is a follow form. 30-day notice of cancellation <br />except 10 days for non-payment. General Liability is primary and non-contributoryto other insurance available to the <br />certificate holder, but only to the extent required by written contract with the insured. A waiver of subrogation in favor of <br />Additional Insured as respect the General Liability, Auto Liability and pursuant to a written contract. <br />i5 <br />CERTIFICATE HOLDER <br />CANCELLATION <br />3E3 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />POLICY PROVISIONS. <br />City of Santa Ana <br />AUTHORIZED REPRESENTATIVE <br />Risk Management Division <br />20 Civic Center Plaza, 4th <br />Santa Ana CA 92701 USA <br />Floor - <br />c-�ayy J <br />f� <br />�r .: PavlEwmSaPPRDvmsv: <br />91 ' Todd Pwwon <br />01988-2015 ACORD COR I- md<Mnnagar„mranimrade <br />ACORD 25 (2016103) <br />The ACORD name and logo are registered marks of ACORD <br />