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SPECIAL EVENT LIABILITY GROUP INSURANCE TRUST DATE <br />CERTIFICATE OF INSURANCE ENDORSEMENT 8114/2024 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, <br />EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE ENDORSEMENT DOES NOT CONSTITUTE A CONTRACT <br />BETWEEN THE ISSUING MSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />PRODUCER: CONTACTNAME: JOYCUMMINGS <br />HUB International Insurance Services Inc. PHONE 9256096500 FAX 9256096550 <br />3000 Executive Parkway, Suite 300 EMAIL soecialevent().hubinternational.com <br />San Ramon, CA 94583 INSURER(S) AFFORDING COVERAGE NAIC # <br />CA License #0757776 INSURER A: Colony Insurance Company 39993 <br />NAMED INSURED: <br />Chicano Heritage: Educational Celebration of <br />Culture at the Library Vendors (8) <br />per the attached list <br />20 Civic Center Plaza, Santa Ana, CA 92701 <br />COVERAGES <br />This is to certify that the policies of insurance listed below have been issued to the insured named above for the event dates) indicated below. Notwithstanding any requirement, tens o <br />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 <br />terms, exclusions and conditions of such policies. <br />INSURED MEMBER <br />LT R R TYPE OF INSURANCE ENDORSEMENT COVERAGE EFFECTIVE / LIMITS <br />NUMBER EXPIRATION DATE <br />A GENERAL LIABILITY EAcnoccuaRENCE $1.000,DDO <br />% COMMERCIAL GENERAL LIABILITY 41528 08/29/2024 DAMAGE TO RENTED PREMISES <br />(Ea aaa,reaa) $1,000,DOO <br />CLAIMS -MADE Fxl <br />OCCURRENCE MED UP (My one person) $5,000 <br />PERSONAL a AOV INJURY $1,000,000 <br />GENERALAGGREGATE $z,o00,000 <br />PRODUCTS-COMPIOPAGG $2.000,000 <br />UQUORLIABILITYPER <br />OCCURRENCE (AGGREGATE <br />INCLUDED IN GENERAL UAMLITY n/a <br />AGGREGATE) <br />MASTER POLICY #103 GL 0021111 - EFFECTIVE DATE Ill 12024; EXPIRATION 1/112025 <br />DESCRIPTION OF OPERATIONS / LOCATIONS <br />City of Santa Ana, its officers, officials, employees and volunteers, 20 Civic Center Plaza, Santa Ana, CA 92701 <br />is/are Included as an additional insured(s) per attached endorsement T5409-0118. Pol Icy Is Primary and Non-contributl ng per attached endorsement T1095-0108; Waiver of <br />Subrogation applies per attached endorsement CG 24 04 05 09. <br />Event Type: Vendors(8) <br />Event date(s): 8/29/2024 <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE <br />BEFORE THE EXPIRATION DATE _ � �1� -_ <br />ACCORDANCE WITH THE POLICY "'� ` <br />City of Santa Ana REVIEWED&APPROV®BY: <br />Attention: Ella Sepulveda AUTHORIZED REPRESENTATIVE el,- s 're" A4,fr:4 Ac[444 <br />20 Civic Center Plaza M-75 ®' Risk Management Specialist <br />Santa Ana, CA 92701. <br />