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/-004 SLATSER-01 IJACKSON
<br />,4.. R CERTIFICATE OF LIABILITY INSURANCE DATrIYYYI
<br />`� a12n9120snoza
<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 endorsem e'l
<br />NAME�PRODUCER License # OM63276 CONTACT LIS I P!L/8QqiWly siqned by Ai
<br />Hardy Insurance Services, Inc. I PHONE s FAx
<br />2911 Bonita Avenue Suite A ac, No Ext: ( D9) 9 - 76 7 PIC, No :(909) 593-5477
<br />La Verne, CA 91750 E-MAIL . I e 1 T
<br />F E
<br />INSURERA Stery eci U a an 9
<br />INSURED INSUREP 3:CallfOr Oblle Insurance Company 38342
<br />Slate Service Group, LLC IN9JP_RC:ASCOt ci nsurance Com an 45055
<br />22600 Savi Ranch Pkwy, Suite A27 INSURER D :State Compensation Insurance Fund of California 35076
<br />Yorba Linda, CA 92887
<br />COVERAGES CERTIFICATE NUMBER- RFVIRION NIIIkARER-
<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 />ADDLSUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />IYYYI
<br />LIMITS
<br />A
<br />X
<br />COMMERCMLGENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />X
<br />WSGL000164
<br />1012512023
<br />10125/2024
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />100,000
<br />X
<br />MED EXP (Any one arson
<br />5,000
<br />Errors & Omission
<br />PERSONAL &AOV INJURY
<br />1,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER.
<br />X POLICY LOC
<br />GENERAL AGGREGATE
<br />2,000,000
<br />PRODUCTS - COMPIOP AGG
<br />2,000,000
<br />$
<br />OTHER:
<br />6
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJURY Per (aeon
<br />$
<br />ANY AUTO
<br />BA040000067165
<br />4/14/2024
<br />4/14/2025
<br />IX
<br />BODILYINJURY Peraccldent
<br />S
<br />OWMED X SCHEDULED
<br />AUTOS ONLY 'SCHEDULED
<br />TO{S
<br />Pear aoatlenDAMAGE
<br />$
<br />AUT OS ONLY X AUTOS ONLDY
<br />8
<br />CUMBRELLA
<br />DAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 6,000,000
<br />dX
<br />AGGREGATE
<br />S 5,000,000
<br />EXCESS DAB
<br />CLAIMS -MADE
<br />ESXS2310001475-02
<br />10/25/2023
<br />10/2512024
<br />DED I I RETENTION$
<br />D
<br />WORKERS COMPENSAAND EMPLOYERS'LIABIILOITY
<br />ANYPROPRIETOR/PARTNERIEXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />9263790-23
<br />11/8I2023
<br />111812024
<br />E FIR OTH-
<br />X PERTU
<br />E.L. EACH ACCIDENT
<br />S 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />1,000,000
<br />DIf ESCRIPTION
<br />NOFOe Loder
<br />DESCRIPTION OF OPERATIONS below
<br />E. L. DISEASE - POLICY LIMIT
<br />S 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached U mores ace is required)
<br />NOTE #1: $5MM Limit tat Layer EXC LIAB provides Following Form excess limits over underlying CGC/E&O noted policy.
<br />NOTE #2: $4MM Limit 2nd Layer EXC LIAB provides Following Form excess limits over underlying CGL/E&O & $5MM Limit tat Layer EXC LIAB noted
<br />policies.
<br />City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers are included as additional insured per CIGL79 (03118).
<br />GIL waiver of subrogation applies per CG2404 (05/09).
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />ACORD 25 (2016/03)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREO
<br />ACCORDANCE WITH THE POLICY PR(
<br />AUTHORIZED REPRESENTATIVE
<br />,E ' ' `V
<br />RWeMaugemmtDMe[on
<br />RIN7EWED&APPROVED BY:
<br />4atlIlilil'
<br />®
<br />A, f4 Acwd.
<br />Risk Management 5proalist
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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