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MATSONMA04 GROLLINGS '4CCJR0 CERTIFICATE OF LIABILITY INSURANCE DATE YYI 91812 �--� 91a12o25 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 Jay Jay Janssens NAME: Acrisure West Insurance Services,LLC PHONE FAX 1950 W Corporate Way (A/C,No,Ext): (AIC,No): 91 ADDRess:jjanssens@acrisure.com Anaheim,CA 9 2801-53 73 INSURERISI AFFORDING COVERAGE NAIC 9 INSURER A:State Compensation Insurance Fund of California 35076 INSURED ENSURER B Mark Matson dba Temecula Carriage Company,LL,C INSURER C 40001 Berenda Road kNSURERD: Temecula,CA 92591 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 ADDLSUBR POLICY IPOLICY EX? LTR TYPE of INSURANCE IN ❑ WVD POLICY NUMBER M DDIYYYY MlDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES lEa occurrence $ MED EXP(Any oneperson) $ PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY❑JECT D LOG PRODUCTS-COMPfOP AGG I $ OTHER S AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT Ea accident S ANY AUTO BODILY INJURY Per person S _ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED - PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $H r $ LUMI1.R,ELLA LIAR HOCCUR EACH OCCURRENCES LIAR CLAIMS-MADE AGGREGATE 5 DED RETENTION 5 5 A WORKERS COMPENSATION XPER AND EMPLOYERS'LIABILITY YIN STATUTE EORH :ANY PROPRIETORIPARTNERlEXECUTIVE ❑ X 9125855-25 212612025 2126/2026 1,000,000 OFFICIAMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ .(Mandatary in NH) E.L.❑ISEASE-EA EMPLOYE S 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S i DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Waiver of Subrogation applies to the City of Santa Ana,its City Council,its officers,officials,employees,agents,and volunteers *30 days notice of cancellation applies to all liability;10 days notice for non-payment of premium. APPROVED CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 12:54 phi,Sep 77,2025 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attention: Parks,Recreation,and Community Services Agenc 20 Civic Center Plaza Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD