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ACC>R®r CERTIFICATE OF LIABILITY INSURANCE F DATE(MMfDD1YYYY) 06/0612025 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 CIAI NAME: Collectors Insurance Agency, Inc. 3200 Courthouse Lane PHONE Ext : {952) 926-6547 'FAX No : (952) 928-3837 E-MAIL 5: eollectorsinsurance@acainternational.org INSURERS) AFFORDING COVERAGE NAIC # Eagan MN 55121 INSURERA: Nationwide Assurance Company 10723 INSURED INSURER B : Nationwide Mutual Insurance Company 23787 Be Services, Inc. INSURER C : 550 DISC Dr INSURER D : INSURER E Longmont CO 80503-9343 INSURERF: COVERAGES CERTIFICATE NUMBER: 10013709 REVISION NUMBER: THIS IS TO CERTIFYTHATTHE PCLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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. INSR LTR TYPE OF INSURANCE AUDL INSD sUHR WVD POLICY NUMBER POLICY EFF MM1DDlYYYY POLICY EXP MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MARE � OCCUR EACH OCCURRENCE $ 1,000,000 'DAMArE TO RENTED PREMISES Ea occurrence) $ 300,000 MED EXP (Any one person} $ 5.000 PERSONAL&ADVINJURY $ 1,000,000 A Y ACPBPO13140083377 03/2312025 03/23/2026 GEN'L AGGREGATE LIMIT APPLIESPER: POLICY LF7 JPECT 7LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGO $2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident)$ INCLUDED INGL BODILY l NJ URY(Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS ACPBP013140083377 03/23/2025 03/23/2026 BODILY INJURY (Per accident) $ HIRED v NON -OWNED AUTOS ONLY /� AUTOS ONLY v PROPERTY DAMAGE Per accident $ 5 x UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 B EXCESS LIAB CLAIMS MADE ACPCU013140083377 03/23/2025 0312312026 DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERfEXECUTIVE OFFICERIM£MBER EXCLUDED? NIA PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes. describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS be€ow DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if more space is required) TLI Tra Il Digitally sign Tu Tran Ngu IT IS AGREED THAT CITY OF SANTAANA IS iiLUDED AS ADDITIONAL INSURED SOLELY AS THEIR INTERESTS MAY APPEAR IN ACCORDANCE ❑ate:2025.❑ WITH THE PROVISIONS OF THE POLICY FORM. Nguyen aBas:3o-ar APPROVED By Tu Tian Nguyen at 8,15 am, Jul 11, 2025 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF SANTAANA ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1988 I AUTHORIZED REPRESENTATIVE SANTAANA CA 92702 ' @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD