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V11 F I1=1 alll I Date:2022.05.0310:47:40-07'OU <br />AC 0® CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM DD VYYV) <br />04/28/2022 <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 pollcy(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 endorsement(s). <br />PRODUCER <br />CONTACT Nancy Stoltlemyer <br />NAME: <br />Insurance Brokers of MD - Hagerstown <br />PHONE (301) 790-0652 PAX (301) 790-0962 <br />A/C No Ext: AIC No: <br />13126 Pennsylvania Ave. <br />nooaesE. nancy.stottlemyerr@lbmofmd.com <br />PO Box 3767 <br />INSURER($) AFFORDING COVERAGE <br />NAIL# <br />INSURER A: Twin City Fire Ins. Co. <br />29459 <br />Hagerstown MD 21742 <br />INSURED <br />INSURER B: Hartford A8,1 Co. <br />22357 <br />The Library Corporation <br />INSURER C: Hartford Casualty Ins. Co. <br />29424 <br />Carl Corporation and Tech -Logic Corporation <br />INSURER D: Hartford Fire Ins. Co. <br />19882 <br />1 Research Park <br />INSURER E: <br />Inwood WV 25426 <br />1 INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 2022-2023 REVISION NUMBER: <br />THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR R <br />TYPE OF INSURANCE <br />INSD <br />WVO <br />POLICY NUMBER <br />MMIDO/YYYY <br />MMIDDIYYYY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADE X OCCUR <br />EACHOCCURRENCE <br />$ 1,000,000 <br />DAMAGE TRENTED <br />O <br />PREMISES Ea occurrence <br />$ 1,000,000 <br />MED EXP(Any one arson) <br />$ 10,000 <br />PERSONALaADV INJURY <br />$ 1,000,000 <br />A <br />Y <br />30SBAVK5698 <br />05108/2022 <br />0510812023 <br />GEWLAGGREGATE LIMITAPPLIES PER: <br />PRO � LOC <br />POLICY � ECT <br />GENERALAGGREGATE <br />$ 2,000,000 <br />PRODUCTS - COMPIOPAGG <br />$ 2,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINEDSINGLE LIMIT <br />Ea accldent <br />$ 1,OOQ000 <br />X <br />BODILY INJU RY(Per person) <br />$ <br />ANYAUTO <br />B <br />OWNED SCHEDULED <br />AUTOS ON LV AUTOS <br />3OUECFP3134 <br />05/08/2022 <br />05/00/2023 <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Per accident) <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />$ <br />X <br />UMBRELLA LIAB <br />v <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 6,000,000 <br />AGGREGATE <br />$ 6,000,000 <br />A <br />LIAB <br />CLAIM&MADE <br />30SBAVK5698 <br />05/08/2022 <br />05/08/2023 <br />IEXCEBS <br />DED X1 RETENTION $ 10,000 <br />$ <br />Q <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY y/N <br />CUTIVE <br />ANY PROPRIETOREXCL EXCLUDED? <br />EM BER EXCLUOE09 <br />(MandaOFFICtory NH) <br />IMes, <br />NIA <br />30WECAD2KBN <br />05/08/2022 <br />05/08/2023 <br />X SPER TATUTE ERH <br />E.L. EACH ACCIDENT <br />1,000,ODO <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />describ <br />If DESCRIPTION <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />1,000,000 <br />$ <br />D <br />E&O, Information Risk, Media Liability & <br />First Party Expense -Claims Made <br />30TE0336969-22 <br />05108/2022 <br />05/08/2023 <br />Policy Aggregate <br />Wrongful Act <br />Each Wron 9 <br />$5,000,000 <br />$5,000,000 <br />Retention <br />$ 25,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required) <br />City of Santa Ana, It's Officers, employees, agents, volunteers and representatives are additional insured as indicated, and coverage is primary, <br />non-contributory when required by written contract. Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation. <br />City Of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza 4th FI <br />Santa Ana <br />ACORD 25 (2016/03) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />CA 92702 ' F4 1 <br />RENEWED 6APPaovm lM <br />01988-2015 ACORD COI a <br />The ACORD name and logo are registered marks of ACORD 7mw Pww" <br />R61<ManaDenxnr CledwlArtle <br />