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DATE(MM/DD/YYYY) <br /> A�" CERTIFICATE OF LIABILITY INSURANCE <br /> 04/03/2025 <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 policy(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 CONTACT NAME: — <br /> Safebuilt Insurance Services LLC PHONE 760-599-7242 (FAX <br /> AJC 866-467-6701 <br /> (A/C,No,Ext): (A/C,No): <br /> E-MAIL <br /> 1811 ASTON AVE SUITE 200 ADDRESS: — <br /> CARLSBAD,CA92008 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA: Employers Preferred Insurance Company 10346 <br /> INSURED INSURER B: — — <br /> ULTIMATE ENTERTAINMENT LLC INSURERC: — — <br /> 12104 PARK ST INSURER D: — — <br /> CERRITOS,CA90703-1842 INSURERE: — — <br /> INSURER F: — — <br /> COVERAGES CERTIFICATE NUMBER:— 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 <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICYNUMBER MM/DD MM/DD <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE — <br /> ❑ CLAIMS-MADE ❑ OCCUR DAMAGE TO RENTED — <br /> PREMISES Ea occurrence <br /> MED EXP(Any one person) — <br /> PERSONAL&ADV INJURY — <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE — <br /> POLICY PRO- LOC PRODUCTS-COMP/OP AGG — <br /> JECT <br /> OTHER: — — — <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident — <br /> ANY AUTO BODILY INJURY(Per person) - <br /> - OWNED SCHEDULED — — — — — BODILY INJURY(Per accident) — <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY Per accident — <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE - <br /> - EXCESS LIAB CLAIMS-MADE — — — — — AGGREGATE — <br /> DED RETENTION — — — <br /> WORKERS COMPENSATION ✓ STATUTE OERH — <br /> AND EMPLOYERS'LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVEY/N E.L.EACH ACCIDENT $1,000,000.00 <br /> A OFFICER/MEMBER EXCLUDED? N/A Y EIG561248700 06/05/2024 06/05/2025 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000.00 <br /> If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000.00 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) <br /> The following are excluded from coverage: STEVEN NERO <br /> Waiver of Subrogation applies on worker's compensation policy per written contract."City of Santa Ana,its City Council,officers,officials,employees,agents, <br /> and volunteers." <br /> APPROVED <br /> By Tu Tran Nguyen at 9:08 am,Apr 07,2025 <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Santa Ana <br /> ATTN:Attention: Parks, Recreation,and Community Services Agency SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> EMAIL:jhoang@santa-ana.org THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 20 Civic Center Plaza M-23 <br /> Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE <br /> @ 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br />