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DATE(MMroD1YYYV) ACRE) 03127l2025 1i CERTIFICATE OF LIABILITY INSURANCE ACCt#:3036240 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 NAME: LOCKTON AFFINITY,LLC LOCKTON AFFINITY, LLC PHONE FAX P.O. BOX 879610 (AIC,No.i (AIC,1913 552-7599 KANSAS CITY, MO 64187-9610 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Arch Insurance Company 11150 INSURED INSURER B Industrial Medical Support,Inc. 5639 Hansel Avenue INSURER C: Edgewood,FL 32809 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 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 TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSO WVD POLICY NUMBER (MMIDDM'YY) (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS- OCCUR PREMISES E n $ MED EXP(Any oneperson) $ PERSONAL 6 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY QPRO- ❑LOC I I IF:(.T PRODUCTS-COMP/OP AGG $ THE,: A AUTOMOBILE LIABILITY X X LAAUT0066801 01/0112025 01/01/2026 I LE IMI $1,000,000 Ea ac ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY X AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (For nor,dentl UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER A NY P ROPR IETORIPA RTN ER/EXECU TI V E OFFICERIMEMBER EXCLUDED? N 1 A E.L.EACH ACCIDENT $ (Mandatory In Ni If yes,describe under E.L.DISEASE-EAEMPLOYEE DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)GPBR: POLICY PROVIDES PROTECTION FOR ANY AND ALL OPERATIONSIJOBS PERFORMED BY THE NAMED INSURED WHERE REQUIRED BY WRITTEN CONTRACT.CERTIFICATE HOLDER IS AN ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT.WAIVER OF SUBROGATION INCLUDED BY WRITTEN CONTRACT.INSURANCE IS PRIMARY AND NON-CONTRIBUTORY. City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers are included as Additional Insured.A waiver of subrogation applies per written contract. APPROVED By Tu Tran Nguyen at 7:48 am,Apr 23,2025 CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Attn: Parks,Recreation,and Community Services Agency BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana,CA 92702 AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD