ORANGE COUNTY FIRE AUTHORITY (OCFA) (9)

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AC© CERTIFICATE OF LIABILITY INSURANCE °ATE(MM`°°"YYY, 10/2012025 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(les)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 Arthur J. Gallagher Risk Management Services, LLC PHONE FAX 595 Market Street I . 415-546-9300 Arc No):415-536-8499 Suite 2100 ADDRESS: San Francisco CA 94105 INSURER(S)AFFORDINGCOVERAGE NAIC# License#',OD69293 INSURER A:AXA XL Insurance Company UK Limited INSURED FIRFACE-01 INSURER B Orange County Fire Authority P O Box 57115 INSURER C Irvine, CA 926 1 9-7 1 1 5 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:1 6446 36 597 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 LTR TYPE OF INSURANCE JNSD WVDSUBI POLICY NUMBER MMIDDPOLICYrYYYY MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY B1262RT0219724 7/112024 7/1/2029 EACH OCCURRENCE $1,500,000 CLAIMS-MADE �OCCUR DAMAGEORENTED PREMISES Ea occurrence $ MED EXP(Any one person) S PERSONAL&ADV INJURY $1,500,000 C£N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $15,000,000 POLICY D PROJECT LCC PRODUCTS-COMPIOP AGG S X OTHERS Annual PubficOf6cials/EPL $1,500,000 A AUTOMOBILE LIABILITY B1262RT0219724 7l112024 7/112029 COMBINED SINGLE LIMIT $1,500,0D0 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident 5 UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR HCLAIMS-MADE AGGREGATE S DE❑ RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y f N STATUTE I ER. ANYPROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMFMBER EXCLUDED? NIA (Mandatory in NHI E.L.DISEASE-EA EMPLOYEE $ It yes,describe under DESCRIPTION OF OPERATIONS below FL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:As-needed purchase of unleaded and diesel fuel APPROVED By Tu Tran Nguyen at 1Z31 pm,Oct 29,2025 Tu TI-a n plgltaily signed by Tu Tran Nguyen Date:2025.10.29 Nguyen 12:32z2_urcc' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Finance Treasury 1 M-13, 20 Civic Center Plaza P.O. Box 1964 AUTHORIZED REPRESENTATIVE Santa Ana CA 92702f� C�Itry O 1988-2015 ACORD CORPORATION, All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD