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DocuSign Envelope 10: FC7E9346-8A22-4923-BD06-AA30AO439841 ACCWH CERTIFICATE OF LIABILITY INSURANCE DATE(MM/°Drvyv) y,� . 8/28/2023 8/17/2022 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(les) 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 Lockton Companies NAME CT 444 W. 47th Street, Suite 900 _ PHONE _ Fax Exit: ac No Kansas City MO 64112-1906 ,MAIL (816) 960-9000 ADDRESS: kcaBtt@lockton.CODl - INSURERISIAPPORDING COVERAGE ._.. NAICS _ INSURER A: Ztlri h Anterican insurance COi110anY 16535 INSURED DUDEK 4_ L475107 INSURER B; American Guarantee and Llab. Ins. CO. 26247 605 THIRD STREET meuRERc:CGnl DialCasttBL(g., g!]1j21By 20443 ENCINITAS CA 92024 INSURER o : INSURER E ; SURER F: v COVERAGES CERTIFICATE NUMBER: 16765248 REVISION NUMBER: xxxxxxx 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. ILTR TYPE OF INSURANCE POLICY NUMBER POLICY YVF MM%IO EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIM64ADE N OCCUR Y Y GLOO146311 8/28/2022 8/28/2023 EACH OCCURRENCE $ It), OO,OOD RE SES E oco mote $ 100 000 MED E%P (An one person) $ 1 O QOQ _^ PERSONAL SADV INJURY $ 1,000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY Lhl JECT LOC PRODUCTS-COMPIOPAGG $ 2000O00 $ OTHER: A AUTOMOBILE LIABILITY Y Y BAP0146329 S12812022 8/2812023 COMBINED tSINGLE LIMIT $ 1000000 BODILY INJURY (Per person)OWNED $ xi{xxxiiX AUTO NANY f—I AUTOS ONLY AUTOS ULED BODILY INJURY (Pot accident) $ XXXXxxx HIRED NOWOWNED AUTOS ONLY AUTOS ONLY PERT DAMAGE Per accident) $ XXXXXXX s XXXXXXX� I I B X UMBRELLA LIAR I X. I OCCUR N Y AUCII46407 8/28/2022 8/28/2023 EACH OCCURRENCE $ 1 000 000 EXCESS LIAB CWMS•MADE AGGREGATE $ 1 0O 000 DED RETENTION$ $ xxxxxxx A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY OFFICE WMEIMSER EXCLUDED?ECUTIVE rN (Mandatory In NH) NIA Y WC0146330 8l28/2022 8/28/2023 ER TH- X T T ER E.L. EACH ACCIDENT $ 1 000y0Q0 _ W. E.L. DISEASE. EA EMPLOYEE $ ].000.000 If yyet describe under 0 8 RIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 C PROFESSIONAL N N 1,11311111132111 INCLPOLL 8/28/2022 8/28/2023 PER CLAIM$1,000,000 LIABILITY AGGREGATE $2,000,000 INCLUDES POLLUTION DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be alowhod It mom space is required) CITY OF SANTA ANA, OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE ADDITIONAL INSURED ON GENERAL AND AUTO LIABILITY COVERAGE ON A PRIMARY, NON-CONTRIBUTORY BASIS, AS REQUIRED BY WRITTEN CONRACT WAIVER OF SUBROGATION IN FAVOR OF THE ADDITIONAL INSURED APPLIES ON WORK COMP; GENERAL, AUTO AND UMBRELLA LIABILITY COVERAGE, AS REQUIRED BY WRITTEN CONTRACT AND WHERE ALLOW ED BY LAW. COVERAGE 1S SUBJECT TO THE TERMS AND CONDITIONS OF TH6 POLICY. CERTIFICATE HOLDER CANCELLATION See AttaehmentR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 16765248 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF SANTA ANA ACCORDANCE WITH THE POLICY PROVISIONS. RISK MANAGEMENT DIVISION AUTHORIZED REPRESENTATIV. 20 CIVIC CENTER PLAZA SANTA ANA CA 92702 ©198852015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD