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U 1 I r I C I �) V I I Date: 2022,06.23 08:07:19-07'00' AlihiieC>as �® CERTIFICATE OF LIABILITY INSURANCE MMi DATsiz1/zoz2 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 RBN Insurance Services 303 E Wacker Dr Ste 650 CONTACT Tel sa G1650n ffid Np Ex 312-856-9400 IX No:312-856-9425 Chicago IL 60601 AODRIESS, t ibson rbninsurance.com INSURERS AFFORDING COVERAGE NAIC If INSURER A: Underwriters at Lloyds 11041 INSURED ESOURCE-01 E Source Companies LLC 1745 38th St INSURERS: Sentinel Insurance Company 11000 RISURERC: Hartford Insurance Group INSURER D : Boulder CO 83301 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 275018965 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 ADOL SUBR POLICY NUMBER POUCYEFF MMIDDIYYYY EXP MMIDD LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMSWADE OCCUR Y Y 83SBAAE9642 6/14/2022 6/14/2023 EACH OCCURRENCE $1,000,000 PREMIRENTS DAMAGEEa.cc nr PREMISESS ence $1,000,000 MED EXP Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: PRO - PRO- ❑ POLICY JECTLOG GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGO $2,000,000 $ OTHER: C AUTOMOBILE LIABILITY 83UECAF5122 6/14/2022 6/14/2023 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY(Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS( Ix BODILY INJURY Peracicknt )HIRED X AUTOSONON-OWONLY AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ B X UMSRELLAUAB X OCCUR 83SBAAE9642 6/14/2022 6/14/2023 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 EXCESS LIAR CLAIMS -MADE DED I XRETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBEREXCLUDED? a NIA V 83WECADi 6/14/2022 6/14/2023 X STATUTE FOR E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 A Technology/Professional Liability APT1056422 6/14/2022 6/14/2023 Each Claim/Aggregate 5000000 each DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana, The City, its officers, employees, agents, volunteers & representatives are listed as additional insured on primary and non-contributory basis with respect to the General Liability as required by written contract or agreement. Waiver of Subrogation applies in favor of additional insured with respect to the General Liability and Workers Compensation as required by written contract or agreement. 30 Days Notice of Cancellation applies. Umbrella Liability follows the GL. Auto Liability and Workers Camp. City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92701 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 Rift Mmagem,tD Mdai e� - RineE&ED 6 APPROVED BY: 91 dl t1-1:)-' %dre �undoer AMER Risk Management Onio ide ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD