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I UI I r ICI OUI 1 Date: 2022.06.0909:28:11-070m ,A� �® CERTIFICATE OF LIABILITY INSURANCE GATE/2022 mYY) oslOznozz 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 Marsh Risk & Insurance Services 17901 Von Kaman Avenue, Suite 1100 CONTACT NAME: AX PHONE A/c No), E-MAIL ADDRESS: (949) 399-5800; License #0437153 [wine, CA 92614 Attn: Newpor Beach.CertRequest@marsh.com/F. 212-948-4323 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Hartford Fire Insurance Company 19682 CN102166416-STND-GAWUP-22- INSURED Griswold Industries, Cla-Val Company INSURER B : NIA NIA INSURER C : Twin City Fire Insurance Company 29459 1701 Placentia Avenue INSURER D: NIA NIA Costa Mesa, CA 92627-4475 NSURER E: NSURERR COVERAGES CERTIFICATE NUMBER: LOS-00243176046 REVISION NUMBER: 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 ADDLSUBR D WVD POLICY NUMBER POLICY EFF MM/DDmYY) POLICY EXP flMMIDDIYYYYl LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FIOCCUR $1,000,000 SIR 72ECSOA1987 04/01/2022 04/0112023 EACHOCCURRENCE $ 1,000,000 DAMAGE DAMAGES ( RE D Ea occurrence) $ 300,000 X MED EXP Any one person $ PERSONAL B ADV INJURY $ 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO-JECT ❑ LOG OTHER. GENERAL AGGREGATE $ 2,000.000 PRODUCTS-COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY 72UENUM3154 04/0112022 04101/2023 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTYDAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTIONS $ A C WORKERS COMPENSATION AND EMPLOYERS' LIABILDY ANYPROPRIETORIPARTNEWEXECUTIVE YIN OFFICEMMEMBER EXCLUDED? -] (Mandatory in Ni MIf yes,descdbe under DESCRIPTION OF OPERATIONS below NIA 72WNC93100(CA) 72WEH03564 (ADS) 04l01/2022 0 01/2023 04I0112023 X I oTH- STAPERTUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 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) The City of Sans Ana, its officers, employees, agents, volunteers, and representatives are included as additional insured where required by written contract with respect to General Liability. This insurance is primary and non-contributory over any existing insurance and limited to liability arising out ofthe operations of the named insured subject to policy tens and conditions with respect to General Liability. ieaeuoLnea �:La�eJa.1 City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 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 R61rMmgawdllhdan f daiteo &�A1P 91.. // 4li %aeC rJM�aet n 19AR-201A ACORn Cr Rkk Marra9errmmlai,al Aide ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD v 14