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,aCil CERTIFICATE OF LIABILITY INSURANCE IINI F DATE(MMMDh YYY) 1 11/19/2024 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jaime Ritchie NAME: CW Phillips Insurance Services AONN Ext: (661)303-0096 AIC No: 5601 Truxtun Ave, Ste 170 E-MAIL DDRESS: Jaime@cwphillips.com A INSURERS AFFORDING COVERAGE NAIC# Bakersfield CA 93309 INSURER A: Crum 8, Forster Specialty Insurance Company 44520 INSURED INSURER B : RLI Insurance Company 13056 Pro Safety & Rescue, Inc. INSURER C : State Compensation Ins Fund (CA) 3700 Pegasus Dr., Suite 200 INSURER D: LandmarkAmerican 33138 NSURERE; Bakersfield CA 93308 INSURER F: COVERAGES CERTIFICATE NUMBER: 24-25 Master 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE 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. LTR TYPE OF INSURANCE INBD MID POLICY NUMBER PULICYEFF MMIDDIVYYY OLICYEXP MM/DDIYYYY LIMITS x COMMERCIAL GENERALLWBILITY CLAIMS -MADE Fx� OCCUR EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 50,000 MED EXP (Any one arson) $ 5,000 PERSONAL B ADV INJURY S 1,000.000 A Y Y EPK146883 02/15/2024 02/15/2025 GEN'L AGGREGATE LIMITAPPLIES PER: POLICY jECT DLOC GENERAL AGGREGATE $ 2,000.000 PRODUCTS - COMP/OP AGG $ 2,000.000 OTHER: Contractors Pollution s 1,000.000 LIABILITY GDM61NEfT8NJGLEpkAR Es accident $ 1,000,000 BODILY INJURY (Per person) $ ANYAUTO BOWNED X AS AUTOS ONLY AUTOS Y Y CAP9509942 02/15/2024 02/15/2025 POMOBILE BODILY INJURY Per aaichnp s HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 11 PROPERTYDAMAGE Per accident $ Uninsured Motorist BI s 30.000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 10.000.000 AGGREGATE $ 10.000,000 A EXCESS LIAB CLAIMS -MADE Y Y EFX124730 02/15/2024 02/15/2025 DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS be. NIA Y 908944824 02/15/2024 02/15/2025 PER OTH- !� STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 EL.DISEASE -POLICY LIMIT $ 1,000,000 D Medical Malpractice Liability LHC855783 02/15/2024 02/15/2025 General Aggregate Products/Completed Ops $3,000,000 $3,000.000 Personal & Advertising $1,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe adached if more space is required) "' ' Whereby required by written contract or agreement, The City of Santa Ana, its officers, officials, employees, and volunteers are an additional insured and waiver of subrogation under the general liability policy, on a Primary/Non-Contributory basis perform #EN0111-0211 and #EN0347-0217. Additional insured and waiver of subrogation applies to the automobile policy per attached #TRS700-0120 endorsement. Waiver of Subrogation applies to the workers compensation policy per attached #10217-0418 endorsement. Thirty (30) Days Notice of Cancellation will be provided to the additional insured. APPROVED By Cynthia Mora at 9:14 am. Dec 02. 20. CERTIFICATE HOLDER rANCEI 1 ATIOW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Heidi Chou AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza, M-85 Santa Ana CA 92701 51988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD