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�1 41-EAING-111
<br />IMINFDJ
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<br />'4v✓ CERTIFICATE OF LIABILITY INSURANCE
<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.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions -of the policy, certain policies may require an endorsement A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsements .
<br />PRODUCER License # OC41366
<br />Granite Professional Insurance Brokerage, Inc.
<br />360 Lindbergh Avenue "
<br />Livermore, CA 94551
<br />CONTACT
<br />NAME:
<br />PHONE
<br />No, (925) 462-8400 (FNM No 925 462-8888
<br />R( )
<br />n-,%-Ess: commercial@graniteins.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Travelers Property Casualty Company of America
<br />25674
<br />.
<br />INSURED -
<br />111SURERB:EvanstonInsurance
<br />35378
<br />INSURER C:
<br />4LEAF, Inc.
<br />2126 Rheem Dr
<br />Pleasanton, CA 94588
<br />INSURER D:
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES � CERTIFICATE NUMBER Prvlclf)N NUMBER:
<br />THIS IS 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 />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />JR_
<br />- ,TYPE OF INSURANCE
<br />INRD
<br />SUER
<br />mn
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY UP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIALGENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X '
<br />680OJ268720
<br />41912022
<br />41912023
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />DAMAGES ( RENTED
<br />PREMISES cunence)
<br />8 1,000,000
<br />MED EXP (Anyoneperson)
<br />$ 5,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:'
<br />POLICY � PE� LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMP/OPAGG
<br />8 2,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINEDSINGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJURY Per erson
<br />$
<br />X
<br />ANYAUTO
<br />OWNED ASCHEDULED
<br />AUTOS ONLY Ur05
<br />X
<br />X
<br />8107RO25623
<br />4/912022
<br />419/2023
<br />BODILY INJURY Per accident
<br />$
<br />X
<br />ALRTOS ONLY X gONOpW1.�ED
<br />S ONLY
<br />PROPERTY DAMAGE
<br />Peramident
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />I OCCUR
<br />CLAIMS -MADE
<br />CUPIS364055 ..
<br />41912022
<br />4/912023
<br />EACH OCCURRENCE
<br />$ 6,000,000
<br />D
<br />AGGREGATE
<br />$ 6,000,000
<br />LIED I I RETENTION$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNEREXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />OF OPERATIONS below
<br />NIA
<br />X
<br />UB2T357728 ,.
<br />419/2022
<br />W912023
<br />1t PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000DESCRIPTION
<br />B
<br />Professional Liab
<br />MKLV7PL0005281
<br />419/2022
<br />4/912023
<br />Each Claim
<br />2,000,000
<br />B
<br />-
<br />MKLV7PL0005281
<br />4/9/2022
<br />4/912023
<br />Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD tot, Additional Remarks Schedule may be attached H mare spaee is re aired)
<br />The attached forms apply as required per written contract or written agreements between the listed parties any the insured, which are subject to the policy
<br />provisions. In the absence of such written contract or written agreement the attached form may not be applicable.
<br />All operations of the named insured. Certificate holder is named as additional insured to General Liability and Automobile Liability policies per attached
<br />endorsements CG D3 8109 15 and CA T3 53 02 15. Waiver of Subrogation applies to General Liability per endorsement CG D3 8109 15. Waiver of Subrogation
<br />applies to Auto Liability per endorsement CA T3 53 02 15. -
<br />City of Santa Ana, its officers, employees, agents and representatives are Additional Insured on General Liability policy and Automobile Liability policy per
<br />SEE ATTACHED ACORD 101
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CI Of Santa THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City Ana
<br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701 AUTHORUED REPRESENTATIVE
<br />c RAManaganeratDivislon
<br />y° .a• REVIEWED
<br />LG r� 3
<br />ACORD 25 (2016I03) ©1988-2015 ACORD 1 _,
<br />The ACORD name and logo are registered marks of ACORD - Ruk Management specialist
<br />
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