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Digitally signed by Toni Tori Pierson Pierson Date: 2022.07.19 A� & CERTIFICATE OF LIABILITY INSURANCE 11.34:49-0]'00' DA5/1212022YY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND 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 Arthur J. Gallagher & Co. Insurance Brokers of CA., Inc. License #0726293 21820 Burbank Blvd. Suite 175 Woodland Hills CA 91367 CONTACT NAME: Renee PladeraPHONE FAX - 818449-0202 LAIC, Nq: ADugless: Renee lades a' .com INSURER 3 AFFORDING COVERAGE Nac# INSURER A: Sentinel Insurance Company Ltd 11000 License#: 0726293 INSURED 0726293 Carpenter, Rothans & Dumont INSURERS: Employers Preferred Insurance Company 10346 500 S Grand Ave, Suite 1900 INSURER C: I INSURER O: 19th Floor Los Angeles CA 90017 INSURER E: NSURER F COVERAGES CERTIFICATE NUMBER: 603954983 RFVIRIr1N M"MRFR- THIS IS TO CERTIFY THAT THE 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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 ADDLSUSR POLICYNUMSER POLICYEFF MMIDO POLICYEXP MMIDDIYYYY LIMITS A JXCOMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxI OCCUR Y 72SBADZ5095 2/11/2022 2/11/2023 EACH OCCURRENCE $1,000,000 DAMAGE TOR EO PREMISES Ea amurzence $1,000,000 MED EXP (Any one person) $10,000 PERSONAL &AOV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECT LOC GENERALAGGREGATE $2,000,000 PRODUCTS-COMP/OPAGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY 72SBADZ5095 2/11/2022 2/11/2023 OMBI EDISINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident ) $ HHIRED X NON-OWNEO AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per acvtlent $ A X UMBRELLAUAB X OCCUR 72SBADZ5095 2/11/2022 2/11/2023 EACHOCCURRENCE $4,000,000 AGGREGATE $4.000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ in nnn Retention $10,000 B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN EIG4989257-00 5/9/2022 5/9/2023 X STATUTE ER E.L. EACH ACCIDENT $1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED] NIA E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory In NH) If yes, tlescdbe under E.L. DISEASE -POLICY LIMIT 11,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is included as Additional Insured as respects General Liability as required by written contract per policy form SS0008 attached to this policy. "Except 10 days notice of cancellation for non payment of premium. City of Santa Ana 20 Civic Center Plaza P.O. Box 1988 Santa Ana CA 92702 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Risk M.Vesml Dhirbr, - `, � •, lihmivrID&APr9wm Br. B�1WLl lli 1,. %u ;D&U'#,e Ce] 19RR.2019 ArnRO rr RakWna9emm,Oonr lAide ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD I