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ACORo® CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DDIYYYY) <br />06/03/2025 <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 />PRODUCER <br />CONTACT <br />Jonathan Severson <br />Bannister & Associates Insurance Agency <br />PHONE FAX <br />CA License #OL78680 <br />(714) 536-6086 A/C Na:(714) 536-4054 <br />E-MAIL <br />aODRE onathan®bai-ine.com <br />3100 Bristol St., Suite 220 <br />Costa Mesa CA 92626 <br />INSURERS AFFORDING COVERAGE <br />NAICIf <br />INSURERA:Hartford Underwriters Ins. Co. <br />INSURED <br />INSURER B: Hartford Accident & Indemnity <br />Barrios and Associate, LLC <br />INSURERC: Philade hia Indemnity Ins Cc <br />dba Communications Lab <br />INSURER D: AiCh specialty Insurance Company <br />701 B Chapman Avenue <br />INSU RER E: <br />Orange CA 92866 <br />INSU RER F: <br />(949) 215-5539 <br />COVERAGES is CERTIFICATE NUMBER: Cart ID 14777 (132) 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 />INTR <br />R <br />TYPE OF INSURANCE <br />10a <br />SU <br />D <br />POLICYNUMBER <br />POLICY <br />MMIO <br />MM YEXP <br />/DO <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE �% OCCUR <br />Y <br />Y <br />75HABAJBT <br />09/01/2025 <br />04/01/2026 <br />EACH OCCURRENCE <br />$ 11000,000 <br />PREMSES Ea occ.mence <br />$ 11000,000 <br />MED EXP(Any one person) <br />$ 10,000 <br />PERSONALS ADV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO- <br />JECT LOC <br />GENERALAGGREGATE <br />$ 2,000,000 <br />PRODUCTS - COMP/OP AGO <br />$ 2,000,000 <br />$ <br />OTHER: <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 1,000,000 <br />BODILY INJURY(Per person) <br />$ <br />g <br />NYAUTOY <br />72MCCM4329 <br />11/01/202411/01/2025 <br />WNED SCHEDULEDBODILY <br />UTOONLYAUTOBIREDNON-OWNED <br />FMOBISLEUABILITY <br />INJURY (Per accitleM) <br />$ <br />PROPERTY DAMAGEUTOS <br />Per accident <br />ONLY AUTOS ONLY <br />$ <br />A <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />75BABAaBT <br />04/01/2025 <br />04/01/2026 <br />EACH OCCURRENCE <br />$ 6,000.000 <br />AGGREGATE <br />$ 61000,000 <br />EXCESS LIAR <br />CLAIMS -MADE <br />DED I I RETENTIONS <br />Retention <br />$ 10,000 <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILITY YIN <br />PER OTH- <br />STATUTE ER <br />E.L. EACHACCIDENT <br />$ <br />ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ <br />OFFICERIMEMBER EXCLUDED? <br />NIA <br />E.L. DISEASE -EA EMPLOYEE <br />$ <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS bal.. <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />C <br />Professional Liability <br />Y <br />Y <br />FESDIS66043 <br />04/01/2025 <br />04/01/2026 <br />Limit (per <br />claim): <br />$ 2,000,000 <br />Deductible: $5,000/claim <br />Limit (aggregate): <br />$ 4,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) <br />City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers are <br />named as additional insureds with respects general and professional liability policy limits. <br />Primary and non-contributory wording applies with respects general liability policy limits. Waiver <br />of subrogation applies with respects general, auto, and professional liability policy limits. <br />Dpl allyggned <br />Tu Tran by Ta Tran <br />Nguyen APPROVED <br />Nguyen Date:2o25A6.g3 <br />,a:zas3-m'oo' By Tu Tran Nguyen at 2:24 pm, Jun 03, 2025 <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana Police Department <br />AUTHORIZED REPRESENTATIVE <br />60 Civic Center Plaza <br />Santa Ana CA 92701 <br />W <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />Page 1 of 2 <br />