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TE <br /> ,�c`o'rrv® CERTIFICATE OF LIABILITY INSURANCE DA04/011202r 5 ) <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 endorsement(s). <br /> PRODUCFR CONTACT <br /> NAME: <br /> Pinnacol Assurance PHONE FAX <br /> 7501 E.Lowry Blvd. I <br /> AIC Na Ext: Arc Na. <br /> .-MAIL <br /> Denver,CO 80230-7006 ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Pinnacol Assurance 41190 <br /> INSURED <br /> INSURER e <br /> 110%,Inc. <br /> PO Box 538 INSURER C: <br /> Salida,CO 81201-0538 INSURER D: <br /> INSURER E; <br /> INSURER F; <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE 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 /> ILTa rvPEOFINSURANCE IINSIDADDL WVD UBR POLICYNUMBER MMILDWYYYY MMtlONYYPY LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 <br /> CLAIMS-MADE1:1 OCCUR DAMAGE <br /> AG O R NTED <br /> PREMISES Ea occurrence 5 <br /> MEO EXP(Any one person) 5 <br /> PERSONAL&ADV INJURY 5 <br /> GENT AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE 5 <br /> POLICY D JECTFRO- <br /> LOC - PRODUCTS-COMPIOP AGG 5 <br /> OTHER: S <br /> AUTOMOBILE LIABILITY C <br /> CMBINED SINGLE LIMIT TS <br /> s accident <br /> ANY AUTO BODILY INJURY(Per person) 5 <br /> OWN ONLY ED SC <br /> AUTOSHEDULEU ) <br /> BODILY INJURY(Per atmldent S <br /> AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY Per accidenl S <br /> S <br /> UMBRELLALIAB OCCUR EACH OCCURRENCE S <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE 5 <br /> DED RETENTION$ _ <br /> WORKERS COMPENSATION STATl1TE OTRH- <br /> AND EMPLOYERS'LIABILITY Y I N <br /> A ©FCERfiRIETOR€XCLUOE1b ECUTIVE iNfA 4240414 11/01/2024 11/01/2025 E.L.EACH ACCIDENT 51,000,000 <br /> (Mandatory in NH) ❑ E.L.{DISEASE-EA EMPLOYEE 51,000,000 <br /> T yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1.000.000 <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS r VEHICLES IACORD 101,Additional Remarks Schedule,may be attached it more space is required) <br /> Unless otherwise stated in the policy provisions,coverage in Colorado only. 110%to provide consulting services for the development of a financial sustainability <br /> strategy to the City of Santa Ana Parks and Recreation Department. <br /> APPROVED <br /> I` <br /> By Tu Tran Nguyen at 2--33 pm,Jun 11,2025 <br /> CERTIFICATE HOLDER CANCELLATION <br /> 2469081 <br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 20 Civic Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Santa Ana,CA 92701-4058 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Glantz@santa-ana.org <br /> AUTHORIZED REPRESENTATIVE <br /> Pinnacol Assurance <br /> 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br /> ACORDs provided by Forms Boss.www.FormsBoss.com; (c) Impressive Publishing 800-208-1977 <br />