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CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 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 riahts to the certificate holder in lieu of such endorsementfsl. PRODUCER Patriot Risk & Insurance Services 18952 MacArthur BIvc�Suite #300 Irvine, CA 92612 „ .� �■ ■ INSURED / S111 Mike Prlich & Sons, Inc. v 5103 Elton St. SUK Baldwin Park CA 91796 ■ INSURI COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEr BE'.OW HAVE BE Hl! Wt&ED NAIAE15 ABWEWR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM C l C'.NDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUPUN-E 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 OF INSURANCE ADOLTYPE JNM WVD SUER POLICYNUMBER MMIUDYEFF UP MM/DD/YYY1 LIMITS A COMMERCIALGENERAL LIABILITY CLAIMS -MADE ✓ OCCUR ✓ GL07143499 - 00 8/1/2023 8/1/2024 EACH OCCURRENCE $1000000 DMA ETORENTED PREMISES Ea occurrence $300,000 ✓ MED EXP (Any one person) $ 5,000 $5 000 Deductible PERSONAL &ADV INJURY $1,000000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 GEN'L POLICY ✓❑ JECT LOG PRODUCTS -COMPIOP AGG $2,000 000 $ OTHER: A AUTOMOBILE LIABILITY BAP7143502 - 00 8/1/2023 8/1/2024 OMBINEED1SINGLELIMIT (Ea acANY $1,000000 BODILY INJURY (Par person) $ AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ B UMBRELLA LIAB ✓ OCCUR TUE405237302 8/1/2023 8/1/2024 EACH OCCURRENCE $10000000 AGGREGATE $10 00Q 000 ✓ EXCESS LIAB CLAIMS -MADE DED RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WC7143497-00 8/1/2023 8/1/2024 ✓ BTATUTE ERR E.L. EACH ACCIDENT $1000000 ANYPROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBEREXCLUDED'1 �N N/A E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1000000 C Pollution Liability/Professional Liab 03139429 8/1/2023 8/1/2024 $10,000,000 Policy Aggregate Professional: Claims Made Poll: $5,000,000 Occur/$10,000,000 Agg Retro Date: 5/9122 Prof Liab: $2,000,000 Occur/Agg Pollution: Occurrence DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Re: Extension of Agreement (A-2021-132-05) for Sewer System Repair Services CITY OF SANTA ANA is named as Additional Insured as respects to General Liability as per endorsement attached as required by written contract. 30-day notice of cancellation / 10-days for non-payment of premium. CITY OF SANTA ANA P.O. Box 1988 20 Civic Center Plaza Santa Ana CA 92702 TION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRC AUTHORREDREPRESENTATWE Dave Jacobson 01988-2015 ACORD v W. RAMuMgemedDivlshm REVIEWED&APPROVEDBY. . Aa r Add ® Rhk Management Specialist Ig ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 80S12810 33/24 GL/AU/UMB/WC/POLL Aehlyn Wooden 16/1"I/2029 1p:39:56 AM (PDT) I Page 1 of 5 This car ificate cancels and supersedes ALL previously issued certificates.