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A — —: _ Diaitallvsianed CERTIFICATE OF LIABILITYTMkANCgWAngieAcevedD OATEIMMIDD/YYYY) ate; 8/2/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CO Uftg-@"tTjIFICATE 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 Patriot Risk & Insurance Services 2415 Campus Drive, Suite #200 Irvine, CA 92612 CONTACT Ep. E 949 486-7900 aC No : E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# www.patrisk.com OK07568 INSURER A: Middlesex Insurance Company 23434 INSURED Mike Prlich & Sons, Inc. Elton 5103 Elton St. INSURER B: Great American Insurance Company 16691 INSURER C: State Compensation Insurance Fund INSURER D:IronshoreSpecialty Insurance Cc 25445 Baldwin Park CA 91706 INSURER E: LIO ds of London INSURER F: GUVCKAtiCS CFRTIFICATF NIIMRFR' Rac RR7cl GG\y1C111M Alt IMAGED. 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 INSURANCElb=jyyoPOLICY ADDL SUER NUMBER POLICYEFF (MWDDNYYYJ POUCYEXP MMIDD/YYYY LIMITS A �/ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F21 OCCUR ✓ A0152818 8/1/2022 8/1/2023 EACH OCCURRENCE $1000000 PREMISES Es .Nccur ante $ 500 000 MED EXP (Any one person) $ 5 000 $5,000 Deductible PERSONAL 8 ADV INJURY $1,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ✓�JE� TOO GENERALAGGREGATE $3,000,000 PRODUCTS - COMP/OP AGG $2000000 $ OTHER: A AUTOMOBILE LIABILITY A0152818 8/112022 8/1/2023 1Eaa llNEeDISINGLE LIMIT 81 OOO OOO BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ B UMBRELLA LIAB ✓ OCCUR TUE405237301 8/l/2022 8/1/2023 EACH OCCURRENCE $10,000.000 ✓ AGGREGATE $1 O,000 000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNEWEXECIfTIVE OFFICERIMEMBEREXCLUDED1 ❑N NIA ✓ 9280970-2022 8/1/2022 8/1/2023 PER OTH- ✓ STATUTE ER L E.L.ACH ACCIDENT $1000000 E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE- POLICY LIMIT $1 000 000 DESCRIPTION OF OPERATIONS below D Pollution Liability ICELLUW00128720 8/1/2022 8/1/2023 $2,000,000 Occur/ $2,000,000 Aggregate $10,000 Deductible. E Professional Liabilit ELOO-98-0066-2022 8/1/2022 8/1/2023 $2,000,000 Occurrence/Aggregate DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured as respects General Liability per endorsement attached. Primary/non-contributory endorsement attached. Waiver of subro as respects WC attached. Excess Liability dec page attached showing the GL in the schedule of underlying 30-day notice of cancellation / 10-days for non-payment of premium. Ct91111#1=1N Clt of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, 4th floor Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE Risk MnugenweiDGidwt Dave Jacobson REVIEWED & APPROVED BY: © 1988-2015 CORD X ft A116V44 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD �'' Risk Management specialist 69558781 1 22/23 GL/AU/OMB/WC/POLL I Wesley Wakely 1 8/2/2022 10:04:10 AM (POT) I Page 1 of B