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ACORL> CERTIFICATE 4F LIABILITY INSURANCE
<br />Ili05/06/2024
<br />FDATE(MWDDIYYYY)
<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
<br />Digitally i
<br />NTACT Shetb Cecena AFIS
<br />James G Parker Insurance Assoc s g n e
<br />Acevedo
<br />//yY`\,
<br />An,
<br />584-3323 FAX (559) 584-9313
<br />A!C o Ext : (AIC,No
<br />nDRESS: shelbyc@jgparker.com
<br />NSURER[S} AFFORDING COVERAGE
<br />NAIC #
<br />■ ■Ce Y ed 0
<br />gieDate:A�[ 4,0
<br />Hanford
<br />INsuRERn: d dmarkAmerican Ins Co
<br />INSURED - 01
<br />INSURER B : National Specialty Insurance CO
<br />22608
<br />Baker Rescue Services Inc
<br />INSURER c : State Compensation Ins Fund
<br />35076.
<br />19744 Beach Blvd #366
<br />INSURER D
<br />INSURER E i
<br />Huntington Beach CA 92648-2988 1INSURER
<br />F
<br />COVERAGES CERTIFICATE NUMBER: 23-24 GLIBAIWCIEX REVISION NUMBER -
<br />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 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
<br />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />VVVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMfDDfYYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE Fx_] OCCUR
<br />EACH OCCURRENCE
<br />1,000.000
<br />PREMISES Ea CCCUrrenCe
<br />50,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL & ADV I NJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />Y
<br />LHC851049
<br />08103/2023
<br />06/0312024
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRO -
<br />POLICY X JECT El LOC
<br />GENERAL AGGREGATE
<br />2,000,000
<br />PRODUCTS-COMIAGG
<br />$ 2,000,000
<br />OTHER:
<br />CGL & Professional Flab
<br />s 2,000,000
<br />AUTOMOBILE
<br />LIABILITY
<br />EaMWNED-SINGLE LIMIT
<br />Ea accident
<br />cS 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTC
<br />B
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Y
<br />Y
<br />GM1060600
<br />08/03/2023
<br />08/03/2024
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Pee accident
<br />$
<br />Uninsured motorist
<br />$ 1,000,000
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />RREN E-
<br />EACH OCCURRENCE
<br />� 5,000,000
<br />AGGREGATE
<br />s 5,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />LHA103784
<br />08/03/2023
<br />08/03/2024
<br />DED I I RETENTION
<br />G
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />AY PROPRIETORlPARTNERIEXECUTIVE
<br />N
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In Ni
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />Y
<br />1851446-2023
<br />091D112023
<br />09101/2024
<br />PER OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT
<br />s 1,OD0,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />S 1.000.000
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space as required)
<br />City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers are included as Additional Insured with respects to General
<br />Liability per attached form RSGO5001 0903 and Automobile Liability per attached form CA2048 1013. Primary & Non-contributory is included with respects to
<br />General Liability per attached form RSG54155 0816. Wavier of Subrogation Applies with respects to General liability, Automobile liability and Workers
<br />Compensation per attached forms RSG54078 0310, CA0444 1013 & 10217 REV.4-2018.
<br />City of Santa Ana
<br />PO Box 1988
<br />20 Civic Center Plaza M-30
<br />Santa Ana
<br />CANCELLATION
<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 PROI
<br />o �.oR.ha Risk MoIngrmentDiviaicm
<br />AUTHORIZED REPRESENTATIVE r REVIEWED &APPROVED BY.
<br />CA 92701 lgs.e �cevaeio
<br />Risk Management Speoalut
<br />ACORD 25 (2016103)
<br />@ 1988-2015 ACC
<br />The ACORD name and logo are registered marks of ACORD
<br />
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