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HomeMy WebLinkAboutRE CONSULTING (RENEE ESCARIO)INSURANCE ON FILE A-2023-194-27 WORK MAY PROCEED UNTIL INSURANCE EXPIRES KQd4'I Z� CITY CLERK AGREEMENT TO PROVIDE ON -CALL ENVIRONMENTAL AND DATE. DEC 0 2 2024 PLANNING SERVICES RELATED TO CEQA AND NEPA C) PPjA(D) IS AGREEMENT is made and entered into this 22nd day of October, 2024 by and between vo,x a vl0r'a ' nee Escario DBA RE Consulting, a Califomia corporation ("Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. On August 17, 2023, the City issued Request for Qualification No. 23-142, by which it sought Consultants to provide on -call environmental, technical, and planning services for the Planning and Building Agency of the City of Santa Ana. The scope of work may include any and all work efforts related to the analysis of a proposed project for compliance with the California Environmental Quality Act (CEQA) and National Environmental Policy Act (NEPA). This may include preparation of required technical studies, peer review of technical studies prepared by others, preparation of Initial Studies, Negative Declarations, Mitigated Negative Declarations, Environmental Impact Reports, Environmental Assessments, Environmental hnpact Statements, and staffing services on an as -needed basis. B. Consultant submitted a responsive proposal that was among those selected by the City. Consultant represents that it is able and willing to provide the services described in the scope of work that was included in RFQ No. 23-142 and attached as Exhibit A. C. Consultant has been selected as one of thirty-five (35) vendors which qualified for this engagement. Only those consultants approved by the City Council on November 7, 2023, shall be eligible to be engaged by the City for these services. D. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional contracting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES a. On an as -needed basis, and at the sole discretion of the City, Consultants shall perform the services that are described in Exhibit A, attached and incorporated by reference as though fully set forth herein. Consultant's proposal is incorporated by reference as though fully set forth herein. When the need for services arise, City may initiate services through use of a letter agreement, executed by the Executive Director of the Planning and Building Agency and the Consultant. Work by the Consultant may not proceed absent a previously engaged or fully executed consultant agreement and letter agreement for a specific project. Page 1 of 10 2. COMPENSATION a. City neither warrants nor guarantees any minimum or maximum compensation to Consultant under this Agreement. Consultant shall be paid only for actual services performed under this Agreement at the rates and charges identified in Exhibit B. Consultant is one of thirty-five (35) Consultants selected to provide environmental and planning services on an as needed basis under RFQ No. 23-142. The total compensation for services provided by all Consultants selected tinder RFQ No. 23- 142 is a collective amount not to exceed four million nine hundred fifty thousand ($4,950,000.00) during the tern of the Agreement, including any extension periods. Where applicable, City shall recognize and pay for any outstanding invoices for work performed by any of the thirty-five (35) selected vendors for building safety consultant services performed by the Consultant for work previously performed for the City. C. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals and Scope of Work, which may reasonably be expected by City. 3. TERM This Agreement shall commence on the date first written above through November 7, 2028, unless terminated earlier in accordance with Section 16, below. 4. INDEPENDENT CONTRACTOR Consultant shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Consultant under this Agreement ("Documents & Data"). Consultant shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Consultant represents and warrants that Consultant has the legal right to license any and all Documents & Page 2 of 10 Data. Consultant makes no such representation and warranty in regard to Documents & Data which were provided to Consultant by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. 6. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Minimum Scope and Limit of Insurance 1. Commercial General Liability (CGL): Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. 2. Automobile Liability: ISO Form Number CA 00 01 covering any auto (Code 1), or if Consultant has no owned autos, hired, (Code 8) and non -owned autos (Code 9), with a limit no less than $1,000,000 per accident for bodily injury and property damage. 3. Workers' Compensation: as required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident for bodily injury or disease. 4. Professional Liability (Errors and Omissions): insurance appropriate to the Consultant's profession, with limit no less than $1,000,000 per occurrence or claim, $2,000,000 aggregate. 5. Broader Coverage: if the Consultant maintains broader coverage and/or higher limits than the minimums shown above, the City requires and shall be entitled to the broader coverage and/or the higher limits maintained by the Consultant. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. b. Other Insurance Provisions 1. Additional Insured Status: The City, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Consultant including materials, parts, or equipment furnished in connection with such work or operations. General liability coverage can be provided in the form of an endorsement to the Consultant's insurance (at least as Page 3 of 10 broad as ISO Form CG 20 10 11 85 or if not available, through the addition of both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 2037 if a later edition is used). 2. Primary Coverage: For any claims related to this contract, the Consultant's insurance coverage shall be primary coverage at least as broad as ISO CG 20 01 04 13 as respects the City, its officers, officials, employees, and volunteers. Any insurance or self- insurance maintained by the City, its officers, officials, employees, or volunteers shall be excess of the Consultant's insurance and shall not contribute with it. 3. Notice of Cancellation: Each insurance policy required above shall provide that coverage shall not be canceled, except with notice to the City. 4. Waiver of Subrogation: Consultant hereby grants to City a waiver of any right to subrogation that any insurer of said Consultant may acquire against the City by virtue of the payment of any loss under such insurance. Consultant agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. 5. Self -Insured Retentions: Self -insured retentions must be declared to and approved by the City. The City may require the Consultant to purchase coverage with a lower retention or provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. The policy language shall provide, or be endorsed to provide, that the self -insured retention may be satisfied by either the named insured or City. Acceptability of Insurers: Insurance is to be placed with insurers authorized to conduct business in the state with a current A.M. Best's rating of no less than A:VII, unless otherwise acceptable to the City. 7. Claims Made Policies (applicable only to professional liability): i. The Retroactive Date must be shown, and must be before the date of the contract or the beginning of contract work. ii. Insurance must be maintained and evidence of insurance must be provided for at least five (5) years after completion of the contract of work. iii. If coverage is canceled or non -renewed, and not replaced with another claims -made policy form with a Retroactive Date prior to the contract effective date, the Consultant must purchase "extended reporting" coverage for a minimum of five (5) years after completion of work. Page 4 of 10 Verification of Coverage: Consultant shall furnish the City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements to City before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive the Consultant's obligation to provide them. The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. 9. Subcontractors: Consultant shall require and verify that all subcontractors maintain insurance meeting all the requirements stated herein, and Consultant shall ensure that City is an additional insured on insurance required from subcontractors. 10. Special Risks or Circumstances: City reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. 7. INDEMNIFICATION Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Consultant or its Consultants, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terns of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The Consultant further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terns of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing, to the extent Consultant's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Consultant. Page 5 of 10 8. INTELLECTUAL PROPERTY INDEMNIFICATION Consultant shall defend, indemnify and hold harmless the City, its officers, agents, representatives, and employees against any and all liability, including costs, and attorney's fees, for infringement of any United States' letters patent, trademark, or copyright contained in the work product or documents provided by Consultant to the City pursuant to this Agreement. 9. RECORDS Consultant shall keep records and invoices in connection with the work to be performed under this Agreement. Consultant shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Consultant under this Agreement. All such records and invoices shall be clearly identifiable. Consultant shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Consultant shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Consultant under this Agreement. 10. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 11. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interest and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 12. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: Page 6 of 10 To City: City Clerk City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax: 714- 647-6956 To Consultant: Executive Director Planning and Building Agency City of Santa Ana 20 Civic Center Plaza (M-20) P.O. Box 1988 Santa Ana, CA 92702 Email: PBAAdmin@santa-ana.org RE Consulting 5742 Calle Polvorosa San Clemente, CA 92673 949-346-4633 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant regarding the subject matter herein, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Consultant. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 14. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without Page 7 of 10 the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other consultants retained by City. 15. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 16. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Consultant to deliver to the City all work product completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 17. NON-DISCRIMINATION Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or any services provided under this Agreement. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 18. JURISDICTION -VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 19. PROFESSIONAL LICENSES Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder Page 8 of 10 and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 20. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: APPROVED AS TO FORM SONIA R. CARVALHO City Attorney By: 4" MELISSA M. CROSTHWAITE Senior Assistant City Attorney RECOMMENDED FOR APPROVAL MINH THAI Executive Director Planning and Building Agency CITY OF SANTA AN iz� LVARO NUNEZ City Manager CONSULTANT ("' n - C%0o,,, Renee Escario President Page 9 of 10 Exhibit A Scope of Services Consultants will be expected to provide experienced and knowledgeable professional staff familiar with federal, state and local regulations including the Santa Ana Municipal Code and General Plan and the CEQA and NEPA. The Consultants' Project Manager and staff shall be responsive and maintain excellent working relationships with project applicant, property owners, developers and City staff. Consultants shall be committed to provide adequate staffing levels at all times in order to adhere to established schedules. All consultants shall provide services under the direction of City staff. Services may include attendance at appropriate City Council, City Commissions, and neighborhood meetings. A. Environmental Services Services include, but are not limited to preparation of documents, distribution and filing of environmental noticing, preparation of studies and technical reports as required by the CEQA and NEPA including, but not limited to, the following as amended and updated from time to time: • Initial Study • Notice of Preparation • Notice of Availability • Notice of Determination • Categorical Exemption • Negative Declaration • Mitigated Negative Declaration • Environmental Impact Report (Program, Focused, Master, Staged) • EIR Addendum, Supplemental EIR, Subsequent EIR • Mitigation and Monitoring Program • Response to Comments • Statement of Overriding Considerations • NEPA compliance documents B. Technical Studies As necessary, prepare any technical studies needed to complete the environmental review or for development projects or City projects as -needed, including but not limited to: • Air Quality Study • Biological Resource Assessment • Cultural Resource Study • Environmental Site Assessments • Economic/Market Study • Geological/Soil Study • Greenhouse Gas Assessment • Health Risk Assessment • Historical Resource Assessment • Hydrology/Water Quality Study • Noise Impact Study • Parking Study • Water Supply Assessment • Mineral Resource Study • Utility/Sewer Study • Traffic Study C. Staffing Services The Planning Division is also seeking qualified professional individuals, firms, or multi -disciplinary teams with experience in current, historic preservation, environmental justice, and advanced planning to assist with processing development project applications, counter services and planning efforts on an as -needed basis. Page 10 of 10 Page 115 FEE SCHEDULE RE Consulting will provide a scope of work and estimated budget for each new project or work program based upon the specific need for each project and the following fee schedule. Labor and Direct Cost Categories Rates RE Consulting CEQA Planning Principal $185-210 per hour Senior CEQA Analyst $140-160 Graphics/GIS $95-120 per hour Black & While Prints/Reproduction $0.20 per page Color Prints/Reproduction (8.5 X 11) $1.00 per page Color Prints/Reproduction (11 X 17) $2.50 per page Mileage Standard IRS Rate Urban Crossroads AQ, GHG, Energy, Noise Technical Studies Principal Technical Specialist $225-295 per hour Senior Associate Technical Specialist $175-235 per hour Associate Technical Specialist $150-195 per hour Senior Analyst/Engineer $120-155 per hour Analyst/Engineer $90-135 per hour Assistant Analyst $80-125 per hour GLA Biological Resource Technical Studies Biological Technical Director $220-280 per hour Biological Project Manager $105-210 per hour Biological Assistant Project Manager $95-155 per hour MCC Cultural Resource and Paleontology Technical Studies Cultural Resources Project Manager $150 per hour Senior Arch/Palen Technical Specialist $130 per hour Arch/Paleo Field Technician/Monitor $90 per hour Translutions Traffic and Transportation Technical Studies Principal Traffic Engineer $275 per hour Senior Transportation Planner $195 per hour Transportation Modeler $100-195 per hour 6 RE Consulting renee@renvconsulting.com r- R CERTIFICATE OF LIABILITY INSURANCE Ro� AC o DarE1) 08/10/I2024 024 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 endorsements . PRODUCER CONTACT CS&S/BIZINSURE LLC PO BOX 958489 NAME: PHONE INC, No. Ext : FAX I= No)'. EMAIL ADDRESS: Lake Mary, FL 32746.8989 INSURER(S) AFFORDING COVERAGE NAIC # 1-877-724.2669 INSURER AContinental Casual Company20443 ' INSURED INSURER B: INSURER C: RENEE ESCARIO DBA RE CONSULTING INsuRER D. 5742 CALLE POLVOROSA INSURERS SAN CLEMENTE, CA 92673 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. NOTWITHSTANDINGANY 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 ADDL IMen 9UeR WVD POLICY NUMBER POLICYEFF MMIDOMY POLICY EXP MMIDDIYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE N OCCUR Y 6020765876 10/08/24 10/08/25 EACH OCCURRENCE S 1,000,000 PREn SEGE E (Ea -I S 1,000,000 MED EXP (Any one person( S 10,000 PERSONAL &ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2,000,000 POLICY -EC-T X LOC PRODUCTS-COMPIOPAGG S 2000000 OTHER A AUTOMOBILE LIABILDY 6020765876 10108124 10/08/25 COMBINED SINGLE LIMIT Ea accident) s 1,000,000 BODILY INJURY(Per person) S ANY AUTO OWNED AUTOS SCHEDULED ONLY AUTO$ BODILY INJURV(Par accident)S PROPERTY DAMAGE (Per accident) $ XHIRED AUTO$ �/ NON -OWNED ONLY X AUTOS ONLY S UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAB CUIIMS-MADE DED I RETENTION S S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER STATUTE OTH- ER ANY PROPRIETOWPARTNEWEXEC.UTIVE OFFICER/MEMBER EXCLUDED? NIA EL EACH ACCIDENT S E.L DISEASE EA EMPLOYEE $ (Mandatory in NH) If yes. describe under E.L. DISEASE POLICY UNIIT S DESCRIPTION OF OPERATIONS below OTHER PER STATUTE OTH- ER E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S E.L. nISFASF- POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAcord 101, Additional Remarks Schedule, may be attached If more space is regdred) Certificate Holder is named as Designated Person Location #1 5742 CALLE POLVOROSA, SAN CLEMENTE, CA, 92673 APPROVED By Cynthia Mora at 9:57 am, Nov 25, 2024 CEK I R-ICA It HULUEK CANCELLATION THE CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 CIVIC CENTER PLAZA ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD CNA SB146932G (Ed. 10-19) BLANKET ADDITIONAL INSURED AND LIABILITY EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COMMON POLICY CONDITIONS TABLE OF CONTENTS I. Blanket Additional Insured Provisions A. Additional Insured — Blanket Vendors B. Miscellaneous Additional Insureds C. Additional Provisions Pertinent to Additional Insured Coverage i.a. Prima — Noncontributory provision 1.b. Definition of "written contract" 2. Additional Insured — Extended Coverage II. Liability Extension Coverages A. Bodily Injury — Expanded Definition B. Broad Knowledge of Occurrence C. Estates, Legal Representatives and Spouses D. Fellow Employee First Aid E. Legal Liability — Damage to Premises F. Personal and Advertising Injury — Discrimination or Humiliation G. Personal and Advertising Injury — Broadened Eviction H. Waiver of Subrogation — Blanket I. BLANKET ADDITIONAL INSURED PROVISIONS A. ADDITIONAL INSURED — BLANKET VENDORS Who Is An Insured is amended to include as an additional insured any person or organization (referred to below as vendor) with whom you agreed under a 'written contract to provide insurance, but only with respect to "bodily injury' or "property damage' arising out of 'your products' which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury' or 'property damage' for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; 6. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or SB146932G (10-19) Page 1 of 7 Copyright, CNA All Rights Reserve APPROVED By Cynthia Mora at 9:57 am, Nov 25, 2 224 SB146932G (Ed. 10-19) h. 'Bodily injury' or'property damage' arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in Subparagraphs d. or f.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 2. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. 3. This provision 2. does not apply to any vendor included as an insured by an endorsement issued by us and made a part of this Policy. 4. This provision 2. does not apply if 'bodily injury' or 'property damage° included within the 'products - completed operations hazard' is excluded either by the provisions of the Policy or by endorsement. B. MISCELLANEOUS ADDITIONAL INSUREDS 1. Who Is An Insured is amended to include as an insured any person or organization (called additional insured) described in paragraphs 3.a. through 3.1. below whom you are required to add as an additional insured on this policy under a 'written contract.' 2. However, subject always to the terms and conditions of this policy, including the limits of insurance, we will not provide the additional insured with: a. A higher limit of insurance than required by such 'written contract;' b. Coverage broader than required by such 'written oontracto and in no event greater than that described by the applicable paragraph a. through k. below; or c. Coverage for 'bodily injury" or 'property damage' included within the 'products -completed operations hazard.' But this paragraph c. does not apply to the extent coverage for such liability is provided by paragraph 3.1. below. Any coverage granted by this endorsement shall apply only to the extent permitted by law. 3. Only the following persons or organizations can qualify as additional insureds under this endorsement: a. Controlling Interest Any persons or organizations with a controlling interest in you but only with respect to their liability arising out of: (1) such person or organization's financial control of you; or (2) Premises such person or organization owns, maintains or controls while you lease or occupy these premises; provided that the coverage granted to such additional insureds does not apply to structural alterations, new construction or demolition operations performed by or for such additional insured. b. Co-owner of Insured Premises A co-owner of a premises co -owned by you and covered under this insurance but only with respect to the co -owners liability for 'bodily injury,' 'property damage' or 'personal and advertising injury' as co- owner of such premises. c. Grantor of Franchise Any person or organization that has granted a franchise to you, but only with respect to such person or organization's liability for 'bodily injury,' 'property damage,' or 'personal and advertising injury' as grantor of a franchise to you. SB146932G (10-19) APPROVED Copyright, CNA All Rights ReservE By Cynthia Mora at 9:57 am, Nov 25, 2024 SB146932G (Ed. 10-19) d. Lessor of Equipment Any person or organization from whom you lease equipment, but only with respect to liability for 'bodily injury,' 'property damage° or 'personal and advertising injury" caused in whole or in part by your maintenance, operation or use of such equipment, provided that the 'occurrence" giving rise to such "bodily injury" or 'property damage' or the offense giving rise to such "personal and advertising injury" takes place prior to the termination of such lease. e. Lessor of Land Any person or organization from whom you lease land, but only with respect to liability for 'bodily injury,' 'property damage" or 'personal and advertising injury' arising out of the ownership, maintenance or use of that specific part of the land leased to you, provided that the 'occurrence' giving rise to such 'bodily injury' or "property damage' or the offense giving rise to such 'personal and advertising injury," takes place prior to the termination of such lease. The insurance hereby afforded to the additional insured does not apply to structural alterations, new construction or demolition operations performed by, on behalf of or for such additional insured. f. Lessor of Premises An owner or lessor of premises leased to you, or such owner or lessor's real estate manager, but only with respect to liability for 'bodily injury,' "property damage' or 'personal and advertising Injury" arising out of the ownership, maintenance or use of such part of the premises leased to you, and provided that the 'occurrence' giving rise to such 'bodily injury' or 'property damage" or the offense giving rise to such 'personal and advertising injury," takes place prior to the termination of such lease. The insurance hereby afforded to the additional insured does not apply to structural alterations, new construction or demolition operations performed by, on behalf of or for such additional insured. g. Mortgagee, Assignee or Receiver A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee, or receiver's liability for "bodily injury,' 'property damage' or 'personal and advertising injury' arising out of the ownership, maintenance, or use of a premises by you. This insurance does not apply to structural alterations, new construction or demolition operations performed by, on behalf of or for such additional insured. h. State or Political Subdivisions A state or government agency or subdivision or political subdivision that has issued a permit or authorization, but only with respect to such government agency or subdivision or political subdivision's liability for 'bodily injury,' 'property damage' or 'personal and advertising Injury' arising out of: (1) The following hazards in connection with premises you own, rent, or control and to which this insurance applies: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance or use of any elevators covered by this insurance; or (2) The permitted or authorized operations performed by you or on your behalf. But the coverage granted by this paragraph does not apply to: (a) 'Bodily injury', 'property damage' or 'personal and advertising injury' arising out of operations performed for the state or government agency or subdivision or political subdivision; or (b) 'Bodily injury' or 'property damage' included within the 'products -completed operations hazard.' With respect to this provision's requirement that additional insured status must be requested under a "written contract,' we will treat as a 'written contract' any governmental permit that requires you to add the governmental entity as an additional insured. SB146932G (10-19) APPROVED Copyright, CNA All Rights Resew By Cynthia Mora at 9:57 am, Nov 25, 2024 SB146932G (Ed. 10-19) t. Trade Show Event Lessor With respect to your participation in a trade show event as an exhibitor, presenter or displayer, any person or organization whom you are required to include as an additional insured, but only with respect to such person or organization's liability for 'bodily injury,' 'property damage,' or 'personal and advertising injury' caused by: a. Your acts or omissions; or b. Acts or omissions of those acting on your behalf; in the performance of your ongoing operations at the trade show premises during the trade show event. J. Other Person or Organization Any person or organization who is not an additional insured under paragraphs a. through I. above. Such additional insured is an insured solely for 'bodily injury,' "property damage° or 'personal and advertising injury' for which such additional insured is liable because of your acts or omissions. The coverage granted by this paragraph does not apply to any person or organization: (1) For 'bodily injury,' °property damage,' or °personal and advertising injury" arising out of the rendering or failure to render any professional services; (2) For 'bodily injury' or 'property damage° included in the 'products -completed operations hazard.' But this provision (2) does not apply to such °bodily Injury' or "property damage" if: (a) It is entirely due to your negligence and specifically results from your work for the additional insured which is the subject to the 'written contract'; and (b) The 'written contract' requires you to make the person or organization an additional insured for such 'bodily injury" or 'property damage'; or (3) Who is afforded additional insured coverage under another endorsement attached to this policy. C. ADDITIONAL PROVISIONS PERTINENT TO ADDITIONAL INSURED COVERAGE 1. With respect only to additional insured coverage provided under paragraphs A. and B. above: a. The BUSINESSOWNERS COMMON POLICY CONDITIONS are amended to add the following to the Condition entitled Other Insurance: This insurance is excess of all other insurance available to an additional insured whether primary, excess, contingent or on any other basis. However, if a 'written contract° requires that this insurance be either primary or primary and noncontributing, then this insurance will be primary and non-contributory relative solely to insurance on which the additional insured is a named insured. b. Under Liability and Medical Expense Definitions, the following definition is added: °Written contract' means a written contract or agreement that requires you to make a person or organization an additional insured on this policy, provided the contract or agreement: (1) Is currently in effect or becomes effective during the term of this policy; and (2) Was executed prior to: (a) The 'bodily injury' or 'property damage;' or (b) The offense that caused the'personal and advertising injury"; for which the additional insured seeks coverage. 2. With respect to any additional insured added by this endorsement or by any other endorsement attached to this Coverage Part, the section entitled Who Is An Insured is amended to make the following natural persons insureds. If the additional insured is: a. An individual, then his or her spouse is an insured; SB146932G (10-19) APPROVED Copyright, CNA All Rights Resery By Cynthia Mora at 9:57 am, Nov 25, 2024 SB146932G (Ed. 10-19) b. A partnership or joint venture, then its partners, members and their spouses are insureds; c. A limited liability company, then its members and managers are insureds; d. An organization other than a partnership, joint venture or limited liability company, then its executive officers, directors and shareholders are insureds; or e. Any type of entity, then its employees are insureds; but only with respect to locations and operations covered by the additional insured endorsement's provisions, and only with respect to their respective roles within their organizations. Furthermore, employees of additional insureds are not insureds with respect to liability arising out of: (1) 'Bodily injury' or'personal and advertising injury' to any fellow employee or to any natural person listed in paragraphs a. through d. above; (2) 'Property damage' to property owned, occupied or used by their employer or by any fellow employee; or (3) Providing or failing to provide professional health care services. It. LIABILITY EXTENSION COVERAGES It is understood and agreed that this endorsement amends the Businessowners Liability Coverage Form. If any other endorsement attached to this policy amends any provision also amended by this endorsement, then that other endorsement controls with respect to such provision, and the changes made by this endorsement to such provision do not apply. A. Bodily injury — Expanded Definition Under Liability and Medical Expenses Definitions, the definition of 'Bodily injury' is deleted and replaced by the following: 'Bodily injury' means physical injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury by that person at any time which results as a consequence of the physical injury, sickness or disease. B. Broad Knowledge of Occurrence Under Businessowners Liability Conditions, the Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended to add the following: Paragraphs a. and b. above apply to you or to any additional insured only when such 'occurrence,' offense, p claim or'suit' is known to: (1) You or any additional insured that is an individual; (2) Any partner, if you or an additional insured is a partnership; (3) Any manager, if you or an additional insured is a limited liability company; (4) Any 'executive officer' or insurance manager, if you or an additional insured is a corporation; (5) Any trustee, if you or an additional insured is a trust; or (6) Any elected or appointed official, if you or an additional insured is a political subdivision or public entity. This paragraph applies separately to you and any additional insured. C. Estates, Legal Representatives and Spouses The estates, heirs, legal representatives and spouses of any natural person insured shall also be insured under this policy; provided, however, coverage is afforded to such estates, heirs, legal representatives and spouses only for claims arising solely out of their capacity as such and, in the rase of a spouse, where such claim seeks damages from marital common property, jointly held property, or property transferred from such natural person insured to such spouse. No coverage is provided for any act, error or omission of an estate, heir, legal representative or spouse outside the scope of such person's rapacity as such, provided however that the spouse of a natural person Named Insured and the spouses of members or partners of joint venture or partnership Named Insureds are insureds with respect to such spouses' acts, errors or omissions in the conduct of the Named Insured's business. SB146932G (10-19) Paoe - of 7 APPROVED Copyright, CNA All Rights Resery By Cynthia Mora at 9:57 am, Nov 25, 2024 SB146932G (Ed. 10-19) D. Fellow Employee First Aid Coverage In the section entitled Who Is An Insured, paragraph 2.a.1. is amended to add the following: The limitations described in subparagraphs 2.a.1.(a), (b) and (c) do not apply to your 'employees' for "bodily injury' that results from providing cardiopulmonary resuscitation or other first aid services to a co -"employee" or "volunteer worker" that becomes necessary while your "employee" is performing duties in the conduct of your business. Your "employees" are hereby insureds for such services. But the insured status conferred by this provision does not apply to "employees" whose duties in your business are to provide professional health care services or health examinations. E. Legal Liability —Damage To Premises 1. Under B. Exclusions, 1. Applicable to Business Liability Coverage, Exclusion k. Damage To Property, is replaced by the following: k. Damage To Property "Property damage" to: 1. Property you own, rent or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; 2. Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; 3. Property loaned to you; 4. Personal property in the care, custody or control of the insured; 5. That particular part of any real property on which you or any contractors or subcontractors working directly or indirectly in your behalf are performing operations, if the "property damage" arises out of those operations; or 6. That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. Paragraph 2 of this exclusion does not apply if the premises are 'your work' and were never occupied, rented or held for rental by you. Paragraphs 1, 3, and 4, of this exclusion do not apply to "property damage" (other than damage by fire or explosion) to premises: (1) rented to you: (2) temporarily occupied by you with the permission of the owner, or (3) to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section D — Liability and Medical Expenses Limits of Insurance. Paragraphs 3, 4, 5, and 6 of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph 6 of this exclusion does not apply to "property damage' included in the "products - completed operations hazard." 2. Under B. Exclusions, 1. Applicable to Business Liability Coverage, the following paragraph is added, and replaces the similar paragraph, if any, beneath paragraph (14) of the exclusion entitled Personal and Advertising Injury: Exclusions c, d, e, f, g, h, i, k, I, m, n, and o, do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner or to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section D. Liability And Medical Expenses Limits Of Insurance. SB146932G (10-19) APPROVED Copyright, CNA All Rights Resent' esery By Cynthia Mora at 9:57 am, Nov 25, 2024 SB146932G (Ed. 10-19) 3. The first Paragraph under item S. Damage To Premises Rented To You Limit of the section entitled Liability And Medical Expenses Limits Of Insurance is replaced by the following: The most we will pay under Business Liability for damages because of "property damage' to any one premises, while rented to you or temporarily occupied by you with the permission of the owner, including contents of such premises rented to you for a period of 7 or fewer consecutive days, is the Damage to Premises Rented to You Limit. The Damage to Premises Rented to You Limit is the greater of: a. $1,000,000; or b. The Damage to Premises Rented to You Limit shown in the Declarations. F. Personal and Advertising Injury —Discrimination or Humiliation 1. Under Liability and Medical Expenses Definklons, the definition of 'personal and advertising injury' is amended to add the following: h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: (1) Not done intentionally by or at the direction of: (a) The insured; or (b) Any 'executive officer,' director, stockholder, partner, member or manager (if you are a limited liability company) of the insured; and (2) Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or person by any insured. 2. Under B. Exclusions, 1. Applicable to Business Liability Coverage, the exclusion entitled Personal and Advertising Injury is amended to add the following additional exclusions: (16)Discrimination Relating to Room, Dwelling or Premises Caused by discrimination directly or indirectly related to the sale, rental, lease or sub -lease or prospective sale, rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any insured. (16)Employment Related Discrimination Discrimination or humiliation directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person by any insured. a (17)Fines or Penalties Fines or penalties levied or imposed by a governmental entity because of discrimination. 3. This provision (Personal and Advertising Injury — Discrimination or Humiliation) does not apply if Personal and Advertising Injury Liability is excluded either by the provisions of the Policy or by endorsement. G. Personal and Advertising Injury - Broadened Eviction Under Liability and Medical Expenses Definitions, the definition of °Personal and advertising injury' is amended to delete Paragraph c. and replace it with the following: c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room dwelling or premises that a person or organization occupies committed by or on behalf of its owner, landlord or lessor. H. Waiver of Subrogation — Blanket We waive any right of recovery we may have against: a. Any person or organization with whom you have a written contract that requires such a waiver. All other terms and conditions of the Policy remain unchanged. SB146932G (10-19) APPROVED Copyright, CNA All Rights Resen By Cynthia Mora at 9:57 am, Nov 25, 2024 CNA SB-146936-A (Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INFLATION GUARD This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form: Inflation Guard 1. The limit of Insurance for Building will be increased by the annual percentage shown in the Declarations, if you choose this optional coverage. The limit of Insurance for Business Personal Property will be increased by the annual percentage shown in the Declarations, if you choose this optional coverage. 2. The amount of increase will be: a. The limit that applied on the most recent of the policy inception date, the policy anniversary date, or any other policy change amending the limit; times SB-146936-A (Ed. 01/06) b. The percentage of annual increase shown in the Declarations, expressed as a decimal (example: 5% is .05); times c. The number of days since the beginning of the current policy year or the effective date of the most recent policy change amending the limit, divided by 365. Example: If: the applicable limit is $100,000. The annual increase is 5%. The number of days since the beginning of the policy year (or last policy change) is 146. The amount of increase is: $100,000 x .05 x 146 / 365 = $2,000. APPROVED By Cynthia Mora at 9:57 am, Nov 25, 2024 Page 1 of 1 ACC>J?or CERTIFICATE OF LIABILITY INSURANCE 141� DAM(MMMDNYYY( 1 09/08/2024 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 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 endomement(s). PRODUCER BizlnsureLLC 2950 Buskirk Ave Suite 300 Walnut Creek, CA. 94597,USA CNAME:ONTACT Pavel YUrkov PHONEranNo, 1-877-900-9998 n/cNe: EWAILss: su ortbizinsure.com INSURERS AFFORDING COVERAGE NAIC d INSURERA: Beludey Insurance Company, Inc. 37540 INSURED Renee Escario DBA RE Consulting 5742 Calle Polyorosa INSURER B: INSURER C INSURERD: SAN CLEMENTE, CA 92673 INSURER E NSURER 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 LTR TYPE OF INSURANCE ADDL J= SUBR MoPOLICY NUMBER POLICY EFF MMIDO/YYYY POLICY UP MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL !LABILITY CLAIMS -MADE ❑OCCUR TO RENTED PREMISES IEa occurrence $ MED EXP An one person $ PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO $ POLICY PRO LOG JFCT $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS Per accitlent BODILY INJURY ( ) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ UCESS LIAR CLAIMS -MADE DEO RETENTION$ $ WORKERS COMPENSATION WC STATU- H- OT AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED9 NIA E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatary in NHl If yes, describe under E.L. DISEASE -POLICY UMIT $ DESCRIPTION OF OPERATIONS below A Professional Liability (E&O) V 169Q924PNPM 10/08/2024 10/08/2025 Coverage: $2,000,000 Aggregate: $2,000,000 Deductible: $1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required( This certificate is issued for evidence purposes only. APPROVED By Cynthia Mora at 9:57 am, Nov 25, 2024 City of Santa Ana Risk Management Division 20 Civic Center Plaza, Santa Ana SANTA ANA, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRESENTATIVE TOT. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CORPORATION. All rinhtB Effective date of this Endorsement: Oct 8 2024 This Endorsement is attached to and forms a part of Policy Number: V169Q924PNPM Beazley Insurance Company, Inc. referred to in this endorsement as either the "Insurer" or the "Underwriters" NUCLEAR EXCLUSION This endorsement modifies insurance provided under the following: BEAZLEY SPECIFIED PROFESSION PROFESSIONAL LIABILITY In consideration of the premium charged for the Policy, it is hereby understood and agreed that this Policy does not apply: Under any Liability Coverage, to injury, sickness, disease, death or destruction: (a) with respect to which an insured under the Policy is also an insured under a nuclear energy liability policy issued by Nuclear Energy Liability Insurance Association, Mutual Atomic Energy Liability Underwriters or Nuclear Insurance Association of Canada, or would be an insured under any such policy but for its termination upon exhaustion of its limit of liability; or (b) resulting from the hazardous properties of nuclear material and with respect to which (1) any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954, or any law amendatory thereof, or (2) the insured is, or had this Policy not been issued would be, entitled to indemnity from the United States of America, or any agency thereof, under any agreement entered into by the United States of America, or any agency thereof, with any person or organization. II. Under any Medical Payments Coverage, or under any Supplementary Payments Provision relating to immediate medical or surgical relief, to expenses incurred with respect to bodily injury, sickness, disease or death resulting from the hazardous properties of nuclear material and arising out of the operation of a nuclear facility by any person or organization. III. Under any Liability Coverage, to injury, sickness, disease, death or destruction resulting from the hazardous properties of nuclear material, if: (a) the nuclear material (1) is at any nuclear facility owned by, or operated by or on behalf of, an insured or (2) has been discharged or dispersed therefrom; (b) the nuclear material is contained in spent fuel or waste at any time possessed, handled, used, processed, stored, transported or disposed of by or on behalf of an insured; or (c) the injury, sickness, disease, death or destruction arises out of the furnishing by an insured of services, materials, parts or equipment in connection with the planning, construction, maintenance, operation or use of any nuclear facility, but if such facility is located within the United States of America, its territories or possessions or Canada, this exclusion (c) applies only to injury to or destruction of property at such nuclear facility. IV. As used in this endorsement: "hazardous properties" include radioactive, toxic or explosive properties; "nuclear material' means source material, special nuclear material or by-product material; "source material', "special nuclear material", and "by-product material' have the meanings given them in the Atomic Energy Act 1954 or in any law amendatory thereof; "spent fuel' means any fuel element or fuel BICMU05090406 APPROVED age 1 of 2 By Cynthia Mora at 9:57 am, Nov 25, 2024 component, solid or liquid, which has been used or exposed to radiation in a nuclear reactor; "waste" means any waste material (1) containing by-product material and (2) resulting from the operation by any person or organization of any nuclear facility included within the definition of nuclear facility under paragraph (a) or (b) thereof; 'nuclear facility" means: (a) any nuclear reactor, (b) any equipment or device designed or used for (1) separating the isotopes of uranium or plutonium, (2) processing or utilizing spent fuel, or (3) handling, processing or packaging waste, (c) any equipment or device used for the processing, fabricating or alloying of special nuclear material if at any time the total amount of such material in the custody of the insured at the premises where such equipment or device is located consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof, or more than 250 grams of uranium 235, (d) any structure, basin, excavation, premises or place prepared or used for the storage or disposal of waste, and includes the site on which any of the foregoing is located, all operations conducted on such site and all premises used for such operations; 'nuclear reactor" means any apparatus designed or used to sustain nuclear fission in a self-supporting chain reaction or to contain a critical mass of fissionable material. With respect to injury to or destruction of property, the word "injury" or "destruction" includes all forms of radioactive contamination of property. All other terms and conditions of this Policy remain unchanged. Authorized Representative APPROVED By Cynthia Mora at 9:57 am, Nov 25, 2024 BICMU05090406 Page 2 of 2 Effective date of this Endorsement: Oct 8 2024 This Endorsement is attached to and forms a part of Policy Number: V169Q924PNPM Beazley Insurance Company, Inc. referred to in this endorsement as either the "Insurer" or the "Underwriters" WAR AND CIVIL WAR EXCLUSION This endorsement modifies insurance provided under the following: BEAZLEY SPECIFIED PROFESSION PROFESSIONAL LIABILITY In consideration of the premium charged for the Policy, it is hereby understood and agreed that notwithstanding anything to the contrary contained herein this Policy does not cover loss or damage directly or indirectly occasioned by, happening through or in consequence of war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, military or usurped power or confiscation or nationalisation or requisition or destruction of or damage to property by or under the order of any government or public or local authority. All other terms and conditions of this Policy remain unchanged. Authorized Representative APPROVED By Cynthia Mora at 9:57 am, Nov 25, 2024 BICMU05070406 Page 1 of 1 Effective date of this Endorsement: Oct 8 2024 This Endorsement is attached to and forms a part of Policy Number: V169Q924PNPM Beazley Insurance Company, Inc. referred to in this endorsement as either the "Insurer" or the "Underwriters" SPECIFIED SERVICES EXCLUSION This endorsement modifies insurance provided under the following: BEAZLEY SPECIFIED PROFESSIONS PROFESSIONAL LIABILITY In consideration of the premium charged for the Policy, it is hereby understood and agreed that the coverage under this Insurance does not apply to Damages, Privacy Notification Costs, Penalties or Claims Expenses in connection with or resulting from any Claim arising out of or resulting from: any financial auditing, accounting, or actuarial services or services as a licensed architect or licensed engineer involved in the sealing or stamping of drawings or documents; 2. any legal services, including, but not limited to: a. services performed for others which by law can only be performed by licensed attorneys; regardless of whether any such services were performed by a licensed attorney; b. services performed for others by a licensed attorney as an administrator, conservator, executor, trustee, guardian or committee or in any similar fiduciary capacity incidental to the practice of law; and C. services performed for others by a licensed attorney as a notary public; 3. any financial advice relating to investments and/or mergers or acquisitions; 4. the performance of, or failure to perform, Professional Services in connection with any entity engaged in the manufacture, sale or advertising of any tobacco products or firearms; 5. any nuclear waste, nuclear facility, nuclear systems, or nuclear weapons, provided, that this exclusion 5. shall not apply to non-nuclear Professional Services performed at nuclear facilities or nuclear systems; or 6. any weapons systems; it is agreed that the term "weapons systems' does not include weapon simulators used for training purposes. All other terms and conditions of this Policy remain unchanged. Authorized Representative APPROVED Pagel of 1 022014 022014 ed. By Cynthia Mora at 9:57 am, Nov 25, 2024 Effective date of this Endorsement: Oct 8 2024 This Endorsement is attached to and forms a part of Policy Number: V169Q924PNPM Insurer: Beazley Insurance Company, Inc. TERRORISM EXCLUSION This endorsement modifies insurance provided under the following: BEAZLEY SPECIFIED PROFESSION PROFESSIONAL LIABILITY In consideration of the premium charged for the Policy, it is hereby understood and agreed that notwithstanding any provision to the contrary within this insurance or any endorsement thereto it is agreed that this insurance excludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any act of terrorism regardless of any other cause or event contributing concurrently or in any other sequence to the loss, including without limitation, loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any action taken in controlling, preventing, suppressing or in any way relating to the foregoing. For the purpose of this endorsement an act of terrorism means an act, including but not limited to the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organisation(s) or government(s), committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear. All other terms and conditions of this Policy remain unchanged. Authorized Representative APPROVED By Cynthia Mora at 9:57 am, Nov 25, 2024 BICMU05080406 Page 1 of 1 Effective date of this Endorsement: Oct 8 2024 This Endorsement is attached to and forms a part of Policy Number: V169Q924PNPM Beazley Insurance Company, Inc. referred to in this endorsement as either the "Insurer" or the "Underwriters" CALIFORNIA AMENDATORY ENDORSEMENT This endorsement modifies insurance provided under the following: BEAZLEY SPECIFIED PROFESSIONS PROFESSIONAL LIABILITY 1. Clause III. THE INSURED AND THE INSURED ORGANIZATION, paragraph G., is replaced by the following: G. The lawful spouse, including any natural person qualifying as a domestic partner under the provisions of any applicable federal, state, or local law in the United States, of any Insured, but solely by reason of any act, error or omission of an Insured other than such spouse or domestic partner. The term spouse shall also include a registered domestic partner under California law. 2. Clause VI. DEFINITIONS, paragraph K. Damages, item 6, is replaced by the following: 6. punitive or exemplary damages; 3. Clause XIV. CANCELLATION, paragraph B. is replaced by the following: B. 1. If this Policy has been in effect for less than sixty (60) days, it may be cancelled by the Underwriters by mailing or delivering to the first Named Insured and producer of record, if any, written notice stating when, not less than sixty (60) days thereafter, such cancellation shall be effective. However, if the Underwriters cancel this Insurance because the Insured has failed to pay a premium when due, this Policy may be cancelled by the Underwriters by mailing or delivering to the first Named Insured and producer of record, if any, written notice stating when, not less than ten (10) days thereafter, such cancellation shall be effective. 2. If this Policy has been in effect for more than sixty (60) days, or if this Policy is a renewal, the Underwriters may only cancel for one or more of the following reasons: (a) nonpayment of premium, including payment due on a prior policy issued by the Underwriters and due during the current policy term covering the same risks; (b) a judgment by a court or an administrative tribunal that the Named Insured has violated any law of this state or of the United States having as one of its necessary elements an act that materially increases any of the risks insured against; (c) discovery of fraud or material misrepresentation by either of the following: (1) The Insured or his or her representative in obtaining the insurance; or (2) The Named Insured or his or her representative in pursuing a Claim under the Policy; (d) Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards, by the Named Insured or his or her representative, which materially increase any of the risks insured against; A01100CA APPROVED Page 1 of 3 022014 ed. By Cynthia Mora at 9:57 am, Nov 25, 2024 (e) Failure by the Named Insured or his or her representative to implement reasonable loss control requirements that were agreed to by the Insured as a condition of policy issuance or that were conditions precedent to the use by the Underwriters of a particular rate or rating plan, if the failure materially increases any of the risks insured against; (f) A determination by the commissioner that the loss of, or changes in, the Underwriters' reinsurance covering all or part of the risk would threaten the financial integrity or solvency of the Underwriters; (g) A determination by the commissioner that a continuation of the policy coverage would place the Underwriters in violation of the laws of this state or the state of its domicile or that the continuation of coverage would threaten the solvency of the Underwriters; or (h) A change by the Named Insured or his or her representative in the activities or property of the commercial or industrial enterprise that results in a material added risk, a materially increased risk, or a materially changed risk, unless the added, increased, or changed risk is included in the Policy. Under this paragraph 6.2., if cancellation is for a reason stated in items 13.2.(b) through B.2.(h), the Underwriters may cancel this Policy by mailing or delivering to the first Named Insured and producer of record, if any, written notice stating when, not less than sixty (60) days thereafter, such cancellation shall be effective. However, if the Underwriters cancel this Insurance because of nonpayment of premium, this Policy may be cancelled by the Underwriters by mailing or delivering a written notice of cancellation to the first Named Insured and producer of record, if any, stating when, not less than ten (10) days thereafter, such cancellation shall be effective. 3. The time of surrender or the effective date and hour of cancellation stated in the notice shall become the end of the Policy Period. 4. Notice will be mailed or delivered to the address shown in the Declarations and shall state the reason or reasons for cancellation. 5. If the notice is mailed, mailing of notice shall be sufficient proof of notice. 4. Clause XIV. CANCELLATION, paragraph F. is replaced by the following: Premium adjustment will be made within eighty (80) business days after the Underwriters first receive notice of the event that generated the unearned premium, but payment or tender of unearned premium is not a condition of cancellation. 5. The following is added to the Policy: NON -RENEWAL A. This Policy may be non -renewed by the Underwriters by mailing or delivering to the first Named Insured and producer of record, if any, written notice at least sixty (60) days, but no more than one hundred, twenty (120) days, before the end of the Policy Period. B Notice will be mailed or delivered to the address shown in the Declarations and shall state the reason or reasons for cancellation. C. If the notice is mailed, mailing of notice shall be sufficient proof of notice. D. No notice is required if: A01100CA APPROVED Page 2 of 3 022014 ed. By Cynthia Mora at 9:57 am, Nov 25, 2024 1. the transfer of, or renewal of, the Policy, without a change in terms or conditions or the rate on which the premium is based between the Underwriters and any members of the Underwriters' same insurance group; 2. the Policy has been extended for ninety (90) days or less, if notice has been given as required in paragraph A. above prior to the extension; 3. the Named Insured has obtained replacement coverage or has agreed, in writing, within sixty (60) days of the termination of the Policy, to obtain that coverage; 4. the Policy is for a period of no more than sixty (60) days and the Named Insured has been notified at the time of issuance that it may not be renewed; 5. the first Named Insured requests a change in the terms or, conditions or risks covered by the Policy within sixty (60) days prior to the end of the Policy Period; or 6. the Underwriters have made a written offer to the first Named Insured, within the time period specified in paragraph A. above, to renew the Policy under changed terms or conditions or at a changed premium rate that results in an increase of more than twenty-five percent (25%). The regulatory requirements set forth in this Amendatory Endorsement shall supersede and take precedence over any provisions of the Policy or any endorsement to the Policy, whenever added, that are inconsistent with or contrary to the provisions of this Amendatory Endorsement, unless such Policy or endorsement provisions comply with the applicable insurance laws of this state. All other terms and conditions of the Policy remain unchanged. Authorized Representative A01100CA APPROVED Page 3 of 3 022014 ed. By Cynthia Mora at 9:57 am, Nov 25, 2024 CALIFORNIA DISCLOSURE NOTICE If this Policy is cancelled by the Named Insured, the Company shall refund ninety percent (90%) of the prorate unearned premium. A01101 CA APPROVED Page 1 of 2 022014 ed. By Cynthia Mora at 9:57 am, Nov 25, 2024 Bizlnsure LLC Effective date of this Endorsement: Oct 8 2024 This Endorsement is attached to and forms a part of Policy Number: V169Q924PNPM Beazley Insurance Company, Inc. referred to in this endorsement as either the "Insurer" or the "Underwriters" This endorsement modifies insurance provided under the following: BEAZLEY SPECIFIED PROFESSIONS PROFESSIONAL LIABILITY In consideration of the premium charged for the Policy, it is hereby understood and agreed that: 1. Clause I., INSURING AGREEMENTS, paragraph C. Privacy Notification Costs, first paragraph is deleted in its entirety and replaced as follows: To pay on behalf of the Insured: Up to one hundred thousand United States dollars (USD $100,000 ) for Privacy Notification Costs, in excess of the Retention and incurred by the Insured Organization with the Underwriters' prior written consent, resulting from the Insured Organization's legal obligation to comply with a Breach Notice Law because of an incident (or reasonably suspected incident) described in Insuring Agreement B.I. or B.2. that first takes place on or after the Retroactive Date and before the end of the Policy Period, is discovered by the Insured during the Policy Period, and is reported to the Underwriters during the Policy Period or as otherwise provided in Clause IX. of this Policy. 2. Clause I., INSURING AGREEMENTS, paragraph D. Regulatory Defense and Penalties is deleted in its entirety and replaced as follows: To pay on behalf of the Insured: Up to one hundred thousand United States dollars (USD $100,000 ) for Claims Expenses and Penalties in excess of the Retention, which the Insured shall become legally obligated to pay because of any Claim in the form of a Regulatory Proceeding, first made against any Insured during the Policy Period or Optional Extension Period (if applicable) and reported in writing to the Underwriters during the Policy Period or as otherwise provided in Clause IX. of this Policy, resulting from a violation of a Privacy Law and caused by an incident described in Insuring Agreement B.1., B.2. or B.3 that first takes place on or after the Retroactive Date and before the end of the Policy Period. 3. Clause V., EXCLUSIONS, B.1. is deleted in its entirety and replaced with the following: if any of the means any principal, partner, corporate officer, director, Manager, general counsel (or most senior legal counsel) or risk manager of the Insured Organization and any individual in a substantially similar position of the Insured Organization (or any person in a substantially similar position as those referenced above, or with substantially similar responsibilities as those referenced above, irrespective of the exact title of such individual, and any individual who previously held any of the above referenced positions) of the Insured Organization on or before the inception date knew or could have reasonably foreseen that such act, error or omission might be expected to be the basis of a Claim; or of the Named Insured on or before the inception date knew or could have reasonably foreseen that such act, error or omission might be expected to be the basis of a Claim; or APPROVED E07313 By Cynthia Mora at 9:57 am, Nov 25, 2024 Page 1 of 3 062015 ed. Bizlnsure LLC 4. Clause VI., DEFINITIONS, HH., Subsidiary, paragraphs 2. and 3. are deleted in their entirety and replaced as follows: 2. acquires Management Control after the inception date of this Policy, provided the revenues of the entity do not exceed twenty five percent (25%) of the Named Insured's annual revenues for the four quarterly periods directly preceding inception of the Policy Period; or 3. acquires Management Control after the inception date of this Policy, provided that if the revenues of the entity exceed twenty five percent (25%) of the Named Insured's annual revenues for the four quarterly periods directly preceding inception of the Policy Period, the provisions of Clause XV., Mergers and Acquisitions, must be fulfilled; 5. Clause IX., NOTICE OF CLAIM, LOSS OR CIRCUMSTANCE THAT MIGHT LEAD TO A CLAIM, paragraphs A. and C. are deleted in their entirety and replaced with the following: A. If any Claim is made against the Insured, the Insured, upon knowledge of the means any principal, partner, corporate officer, director, Manager, general counsel (or most senior legal counsel) or risk manager of the Insured Organization and any individual in a substantially similar position of the Insured Organization, and any individual in a substantially similar position as those referenced above, or with substantially similar responsibilities as those referenced above, irrespective of the exact title of such individual and any individual who previously held any of the above referenced positions, shall forward as soon as practicable to the Underwriters through persons named in Item 9(a) of the Declarations written notice of such Claim in the form of a telecopy, email, or express or certified mail together with every demand, notice, summons or other process received by the Insured or the Insured's representative. Notwithstanding the foregoing, in no event shall the Underwriters be given notice of a Claim later than the end of the Policy Period, the end of the Optional Extension Period (if applicable), or sixty (60) days after the expiration date of the Policy Period in the case of Claims first made against the Insured during the last sixty (60) days of the Policy Period. C. If during the Policy Period, the means any principal, partner, corporate officer, director, Manager, general counsel (or most senior legal counsel) or risk manager of the Insured Organization and any individual in a substantially similar position of the Insured Organization, and any individual in a substantially similar position as those referenced above, or with substantially similar responsibilities as those referenced above, irrespective of the exact title of such individual and any individual who previously held any of the above referenced positions, first becomes aware of any circumstance that could reasonably be the basis for a Claim it may give written notice to the Underwriters in the form of a telecopy, email or express or certified mail through persons named in Item 9(a) of the Declarations as soon as practicable during the Policy Period. Such notice must include: the specific details of the act, error or omission in the provision of Professional Services, or relating to a Security Breach that could reasonably be the basis for a Claim; 2. the injury or damage which may result or has resulted from the circumstance; and 3. the facts by which the means any principal, partner, corporate officer, director, Manager, general counsel (or most senior legal counsel) or risk manager of the Insured Organization and any individual in a substantially similar position of the Insured Organization, and any individual in a substantially similar position as those referenced above, or with substantially similar responsibilities as those referenced above, irrespective of the exact title of such individual and any E07313 Page 2 of 3 062015 ed. APPROVED By Cynthia Mora at 9:57 am, Nov 25, 2024 Bizlnsure LLC individual who previously held any of the above referenced positions, first became aware of the act, error, or omission or Security Breach. Any subsequent Claim made against the Insured arising out of such circumstance which is the subject of the written notice will be deemed to have been made at the time written notice complying with the above requirements was first given to the Underwriters. 6. Clause XV. MERGERS AND ACQUISITIONS, paragraph A., Newly Acquired Subsidiaries, is deleted in its entirety and replaced as follows: A. Newly Acquired Subsidiaries If during the Policy Period the Named Insured or any Subsidiary acquires any entity whose annual revenues are more than twenty five percent (25%) of the Named Insured's total annual revenues for the four quarterly periods directly preceding inception of the Policy Period, then, subject to the Policy Period and all other terms and conditions of this Policy, coverage under this Policy shall be afforded for a period of sixty (60) days, but only for any Claim that arises out of any act, error or omission first committed or incident or event first occurring after the entity becomes so owned. Coverage beyond such sixty (60) day period shall only be available if the Named Insured gives the Underwriters written notice of the acquisition, obtains the written consent of the Underwriters to extend coverage beyond such sixty (60) day period to the entity and agrees to pay any additional premium required by the Underwriters. All other terms and conditions of this Policy remain unchanged. Authorized Representative APPROVED E07313 By Cynthia Mora at 9:57 am, Nov 25, 2024 Page 3 of 3 062015 ed. C/TY OF SANTA ANA RISK MANAGEMENT &&&e 4HUMAN RESOURCES Managing Risk aror rg7 PoSltive Change Affidavit of Exemption for Workers' Compensation Insurance Renee Escario, President (Name/Title) following declaration: hereby affirm under penalty of perjury, the certify on behalf of RENEE ESCARIO DBA RE CONSULTING that during the term (Consultant/Company Name) of my contract for Environmental Consulting services with the City of Santa Ana, (Type of service provided) I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. Date: 10/17/2024 Print Name: Renee Escario Print Title: President Signature: I "-,,) Telephone: 949-346-4633 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPROVED By Cynthia Mora at 9:57 am, Nov 25, 2024 I:\Risk Mgmt\Insurance Requirements\ Affidavit of Exemption for Workers' Compensation Insurance 2021 ACa 10 ` CERTIFICATE OF LIABILITY INSURANCE DATE (MM/20YYYY) ��-- 10/15/ 25 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 endorsements. PRODUCER CONTACT CS&S/BIZINSURE LLC NAME: PO BOX 958489 PHONE FAX (A/C,No,Ext): (A/C,No): LAKE MARY, FL 32746-8989 E-MAIL Phone-877-724-2669 ADDRESS: Fax-877-763-5122 INSURERS AFFORDING COVERAGE NAIC# INSURERA:Continental Casualty Company 20443 INSURED INSURER B: RENEE ESCARIO DBA RE CONSULTING 5742 CALLE POLVOROSA INSURER C: SAN CLEMENTE, CA 92673 INSURERD: 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 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE Z OCCUR DAMAGE TO RENTED 1,000,000 PREMISES(Ea occurrence) A Y Y 6020765876 10/08/2025 10/08/2026 MED EXP(Any one person) 10,0001,000,000 PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: 2,000,000 PRO- GENERAL AGGREGATE POLICY�JECT ® LOC PRODUCTS-COMP/OPAGG 2,000,000 OTHER COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY (Ea accident) ANY AUTO BODILY INJURY(Per person) A Or, SCHEDULED Y Y 6020765876 10/08/2025 10/08/2026 BODILY INJURY(Per accident) AUTOS ONLY AUTOS HIRED NON-OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LABCLAIMS-MADE AGGREGATE DED I RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is added as an additional insured as provided in the blanket additional insured endorsement as it pertains to work being performed by the named insured under written contract. Coverage is Primary and Noncontributory. Waiver of subrogation applies. Digitally signed Tu Tran by TOTran Nguyen Nguyen D..202oeoo8 APPROVED By T. Tran Nguyen at 11:31 am,Jan 08,2026 CERTIFICATE HOLDER CANCELLATION City Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Planning and Building Agency THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD cad4432 7TE(MM/DD/YYYY) acoREY CERTIFICATE OF LIABILITY INSURANCE ��_ /26/2025 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 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 Pavel Yurkov NAME: Bi7lnsure LLC PHONE 1-877-900-9998 FAX 2950 Buskirk Ave Suite 300 E-MAIL o Ext: A/C No Walnut Creek,CA. 94597,USA ADDRESS: supportgbi7insure.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Beazley Insurance Company,Inc. 37540 INSURED INSURER B Renee Escario DBA RE Consulting INSURERC: 5742 Calle Polvorosa SAN CLEMENTE,CA 92673 INSURER D: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD/YYYY MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISESS Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $EC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liability(E&O) X V 16X3U25PNPM 10/08/2025 10/08/2026 Coverage: $2,000,000 Aggregate: $2,000,000 Deductible: $1,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) City of Santa Ana Planning and Building Agency is included as additional insured. CERTIFICATE HOLDER CANCELLATION City of Santa Aria Planning and Building Agency SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2O C1V1C Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE LOAN# ID#: ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CNA (Bid. 10-19 BLANKET ADDITIONAL INSURED AND LIABILITY EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COMMON POLICY CONDITIONS TABLE OF CONTENTS I. Blanket Additional Insured Provisions A. Additional Insured—Blanket Vendors B. Miscellaneous Additional Insureds C. Additional Provisions Pertinent to Additional Insured Coverage 1.a. Prima —Noncontributory provision 1.b. Definition of "written contract" 2. Additional Insured—Extended Coverage II. Liability Extension Coverages A. Bodily In'u —Expanded Definition B. Broad Knowledge of Occurrence C. Estates, Legal Representatives and Spouses D. Fellow Employee First Aid E. Legal Liability—Damage to Premises F. Personal and Advertising In'u —Discrimination or Humiliation G. Personal and Advertising In'u —Broadened Eviction H. Waiver of Subrogation—Blanket I. BLANKET ADDITIONAL INSURED PROVISIONS A. ADDITIONAL INSURED—BLANKET VENDORS Who Is An Insured is amended to include as an additional insured any person or organization (referred to below as vendor) with whom you agreed under a "written contract" to provide insurance, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages 0 that the vendor would have in the absence of the contract or agreement; 0 b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or SB146932G (10-19) Page 1 of 7 Copyright,CNA All Rights Reserved. SB146932G (Ed. 10-19) h. "Bodily injury" or"property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However,this exclusion does not apply to: (1) The exceptions contained in Subparagraphs d.or f.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 2. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. 3. This provision 2. does not apply to any vendor included as an insured by an endorsement issued by us and made a part of this Policy. 4. This provision 2. does not apply if 'bodily injury' or "property damage' included within the 'products- completed operations hazard' is excluded either by the provisions of the Policy or by endorsement. B. MISCELLANEOUS ADDITIONAL INSUREDS 1. Who Is An Insured is amended to include as an insured any person or organization (called additional insured) described in paragraphs 3.a. through 3.j. below whom you are required to add as an additional insured on this policy under a "written contract.' 2. However, subject always to the terms and conditions of this policy, including the limits of insurance, we will not provide the additional insured with: a. A higher limit of insurance than required by such "written contract;" b. Coverage broader than required by such "written contract' and in no event greater than that described by the applicable paragraph a. through k. below; or c. Coverage for "bodily injury" or "property damage' included within the "products-completed operations hazard." But this paragraph c. does not apply to the extent coverage for such liability is provided by paragraph 3.j. below. Any coverage granted by this endorsement shall apply only to the extent permitted by law. 3. Only the following persons or organizations can qualify as additional insureds under this endorsement: a. Controlling Interest Any persons or organizations with a controlling interest in you but only with respect to their liability arising out of: (1) such person or organization's financial control of you; or (2) Premises such person or organization owns, maintains or controls while you lease or occupy these premises; provided that the coverage granted to such additional insureds does not apply to structural alterations, new construction or demolition operations performed by or for such additional insured. b. Co-owner of Insured Premises A co-owner of a premises co-owned by you and covered under this insurance but only with respect to the co-owners liability for "bodily injury," "property damage" or "personal and advertising injury' as co- owner of such premises. c. Grantor of Franchise Any person or organization that has granted a franchise to you, but only with respect to such person or organization's liability for "bodily injury," 'property damage,' or "personal and advertising injury' as grantor of a franchise to you. SB146932G (10-19) Page 2 of 7 Copyright,CNA All Rights Reserved. SB 146932G (Ed. 10-19) d. Lessor of Equipment Any person or organization from whom you lease equipment, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused in whole or in part by your maintenance, operation or use of such equipment, provided that the "occurrence" giving rise to such "bodily injury" or "property damage" or the offense giving rise to such "personal and advertising injury" takes place prior to the termination of such lease. e. Lessor of Land Any person or organization from whom you lease land, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of the ownership, maintenance or use of that specific part of the land leased to you, provided that the "occurrence" giving rise to such "bodily injury" or "property damage" or the offense giving rise to such "personal and advertising injury," takes place prior to the termination of such lease. The insurance hereby afforded to the additional insured does not apply to structural alterations, new construction or demolition operations performed by, on behalf of or for such additional insured. f. Lessor of Premises An owner or lessor of premises leased to you, or such owner or lessor's real estate manager, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of the ownership, maintenance or use of such part of the premises leased to you, and provided that the "occurrence" giving rise to such "bodily injury" or "property damage" or the offense giving rise to such "personal and advertising injury," takes place prior to the termination of such lease. The insurance hereby afforded to the additional insured does not apply to structural alterations, new construction or demolition operations performed by, on behalf of or for such additional insured. g. Mortgagee,Assignee or Receiver A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee, or receiver's liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of the ownership, maintenance, or use of a premises by you. This insurance does not apply to structural alterations, new construction or demolition operations performed by, on behalf of or for such additional insured. h. State or Political Subdivisions A state or government agency or subdivision or political subdivision that has issued a permit or authorization, but only with respect to such government agency or subdivision or political subdivision's liability for"bodily injury," "property damage" or "personal and advertising injury" arising out of: (1) The following hazards in connection with premises you own, rent, or control and to which this 0 insurance applies: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway m openings, sidewalk vaults, street banners, or decorations and similar exposures; or (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance or use of any elevators covered by this insurance; or (2) The permitted or authorized operations performed by you or on your behalf. But the coverage granted by this paragraph does not apply to: (a) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the state or government agency or subdivision or political subdivision; or (b) "Bodily injury" or "property damage" included within the "products-completed operations hazard." With respect to this provision's requirement that additional insured status must be requested under a "written contract,"we will treat as a "written contract" any governmental permit that requires you to add the governmental entity as an additional insured. SB146932G (10-19) Page 3 of 7 Copyright,CNA All Rights Reserved. SB146932G (Ed. 10-19) i. Trade Show Event Lessor With respect to your participation in a trade show event as an exhibitor, presenter or displayer, any person or organization whom you are required to include as an additional insured, but only with respect to such person or organization's liability for 'bodily injury," "property damage,' or 'personal and advertising injury'caused by: a. Your acts or omissions; or b. Acts or omissions of those acting on your behalf; in the performance of your ongoing operations at the trade show premises during the trade show event. j. Other Person or Organization Any person or organization who is not an additional insured under paragraphs a.through i. above. Such additional insured is an insured solely for "bodily injury," "property damage" or 'personal and advertising injury'for which such additional insured is liable because of your acts or omissions. The coverage granted by this paragraph does not apply to any person or organization: (1) For "bodily injury," "property damage,' or 'personal and advertising injury' arising out of the rendering or failure to render any professional services; (2) For 'bodily injury" or 'property damage' included in the "products-completed operations hazard.' But this provision(2)does not apply to such 'bodily injury" or"property damage" if: (a) It is entirely due to your negligence and specifically results from your work for the additional insured which is the subject to the'written contract"; and (b) The "written contract' requires you to make the person or organization an additional insured for such 'bodily injury'or'property damage'; or (3) Who is afforded additional insured coverage under another endorsement attached to this policy. C. ADDITIONAL PROVISIONS PERTINENT TO ADDITIONAL INSURED COVERAGE 1. With respect only to additional insured coverage provided under paragraphs A.and B.above: a. The BUSINESSOWNERS COMMON POLICY CONDITIONS are amended to add the following to the Condition entitled Other Insurance: This insurance is excess of all other insurance available to an additional insured whether primary, excess, contingent or on any other basis. However, if a 'written contract' requires that this insurance be either primary or primary and noncontributing, then this insurance will be primary and non-contributory relative solely to insurance on which the additional insured is a named insured. b. Under Liability and Medical Expense Definitions, the following definition is added: "Written contract' means a written contract or agreement that requires you to make a person or organization an additional insured on this policy, provided the contract or agreement: (1) Is currently in effect or becomes effective during the term of this policy; and (2) Was executed prior to: (a) The "bodily injury'or"property damage;" or (b) The offense that caused the'personal and advertising injury'; for which the additional insured seeks coverage. 2. With respect to any additional insured added by this endorsement or by any other endorsement attached to this Coverage Part, the section entitled Who Is An Insured is amended to make the following natural persons insureds. If the additional insured is: a. An individual, then his or her spouse is an insured; SB146932G (10-19) Page 4 of 7 Copyright,CNA All Rights Reserved. SB 146932G (Ed. 10-19) b. A partnership or joint venture, then its partners, members and their spouses are insureds; c. A limited liability company, then its members and managers are insureds; d. An organization other than a partnership, joint venture or limited liability company, then its executive officers, directors and shareholders are insureds; or e. Any type of entity, then its employees are insureds; but only with respect to locations and operations covered by the additional insured endorsement's provisions, and only with respect to their respective roles within their organizations. Furthermore, employees of additional insureds are not insureds with respect to liability arising out of: (1) "Bodily injury" or 'personal and advertising injury" to any fellow employee or to any natural person listed in paragraphs a.through d.above; (2) "Property damage"to property owned, occupied or used by their employer or by any fellow employee; or (3) Providing or failing to provide professional health care services. II. LIABILITY EXTENSION COVERAGES It is understood and agreed that this endorsement amends the Businessowners Liability Coverage Form. If any other endorsement attached to this policy amends any provision also amended by this endorsement, then that other endorsement controls with respect to such provision, and the changes made by this endorsement to such provision do not apply. A. Bodily injury—Expanded Definition Under Liability and Medical Expenses Definitions, the definition of "Bodily injury" is deleted and replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury by that person at any time which results as a consequence of the physical injury, sickness or disease. B. Broad Knowledge of Occurrence Under Businessowners Liability Conditions, the Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended to add the following: Paragraphs a. and b. above apply to you or to any additional insured only when such "occurrence,' offense, claim or"suit" is known to: (1) You or any additional insured that is an individual; (2) Any partner, if you or an additional insured is a partnership; (3) Any manager, if you or an additional insured is a limited liability company; (4) Any"executive officer" or insurance manager, if you or an additional insured is a corporation; (5) Any trustee, if you or an additional insured is a trust; or (6) Any elected or appointed official, if you or an additional insured is a political subdivision or public entity. This paragraph applies separately to you and any additional insured. C. Estates, Legal Representatives and Spouses The estates, heirs, legal representatives and spouses of any natural person insured shall also be insured under this policy; provided, however, coverage is afforded to such estates, heirs, legal representatives and spouses only for claims arising solely out of their capacity as such and, in the case of a spouse, where such claim seeks damages from marital common property, jointly held property, or property transferred from such natural person insured to such spouse. No coverage is provided for any act, error or omission of an estate, heir, legal _ representative or spouse outside the scope of such person's capacity as such, provided however that the spouse of a natural person Named Insured and the spouses of members or partners of joint venture or partnership Named Insureds are insureds with respect to such spouses'acts, errors or omissions in the conduct of the Named Insured's business. SB146932G (10-19) Page 5 of 7 Copyright,CNA All Rights Reserved. SB 146932G (Ed. 10-19) D. Fellow Employee First Aid Coverage In the section entitled Who Is An Insured, paragraph 2.a.1. is amended to add the following: The limitations described in subparagraphs 2.a.1.(a), (b) and (c) do not apply to your "employees" for "bodily injury" that results from providing cardiopulmonary resuscitation or other first aid services to a co-"employee" or "volunteer worker" that becomes necessary while your "employee" is performing duties in the conduct of your business. Your "employees" are hereby insureds for such services. But the insured status conferred by this provision does not apply to "employees" whose duties in your business are to provide professional health care services or health examinations. E. Legal Liability—Damage To Premises 1. Under B. Exclusions, 1.Applicable to Business Liability Coverage, Exclusion k. Damage To Property, is replaced by the following: k. Damage To Property "Property damage"to: 1. Property you own, rent or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; 2. Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; 3. Property loaned to you; 4. Personal property in the care, custody or control of the insured; 5. That particular part of any real property on which you or any contractors or subcontractors working directly or indirectly in your behalf are performing operations, if the "property damage" arises out of those operations; or 6. That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. Paragraph 2 of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you. Paragraphs 1, 3, and 4, of this exclusion do not apply to "property damage" (other than damage by fire or explosion)to premises: (1) rented to you: (2) temporarily occupied by you with the permission of the owner, or (3) to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section D— Liability and Medical Expenses Limits of Insurance. Paragraphs 3, 4, 5, and 6 of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph 6 of this exclusion does not apply to "property damage" included in the "products- completed operations hazard." 2. Under B. Exclusions, 1.Applicable to Business Liability Coverage, the following paragraph is added, and replaces the similar paragraph, if any, beneath paragraph (14) of the exclusion entitled Personal and Advertising Injury: Exclusions c,d,e,f,g, h, i, k, I,m, in,and o, do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner or to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section D. Liability And Medical Expenses Limits Of Insurance. SB146932G (10-19) Page 6 of 7 Copyright,CNA All Rights Reserved. SB 146932G (Ed. 10-19) 3. The first Paragraph under item 5. Damage To Premises Rented To You Limit of the section entitled Liability And Medical Expenses Limits Of Insurance is replaced by the following: The most we will pay under Business Liability for damages because of "property damage" to any one premises, while rented to you or temporarily occupied by you with the permission of the owner, including contents of such premises rented to you for a period of 7 or fewer consecutive days, is the Damage to Premises Rented to You Limit. The Damage to Premises Rented to You Limit is the greater of: a. $1,000,000; or b. The Damage to Premises Rented to You Limit shown in the Declarations. F. Personal and Advertising Injury—Discrimination or Humiliation 1. Under Liability and Medical Expenses Definitions, the definition of "personal and advertising injury" is amended to add the following: h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: (1) Not done intentionally by or at the direction of: (a) The insured; or (b) Any "executive officer," director, stockholder, partner, member or manager (if you are a limited liability company) of the insured; and (2) Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or person by any insured. 2. Under B. Exclusions, 1. Applicable to Business Liability Coverage, the exclusion entitled Personal and Advertising Injury is amended to add the following additional exclusions: (15)Discrimination Relating to Room, Dwelling or Premises Caused by discrimination directly or indirectly related to the sale, rental, lease or sub-lease or prospective sale, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured. (16)Employment Related Discrimination Discrimination or humiliation directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person by any insured. (17)Fines or Penalties Fines or penalties levied or imposed by a governmental entity because of discrimination. 3. This provision (Personal and Advertising Injury — Discrimination or Humiliation) does not apply if Personal and Advertising Injury Liability is excluded either by the provisions of the Policy or by 0 endorsement. 0 G. Personal and Advertising Injury-Broadened Eviction Under Liability and Medical Expenses Definitions, the definition of "Personal and advertising injury" is amended to delete Paragraph c. and replace it with the following: C. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room dwelling or premises that a person or organization occupies committed by or on behalf of its owner, landlord or lessor. H. Waiver of Subrogation—Blanket We waive any right of recovery we may have against: a. Any person or organization with whom you have a written contract that requires such a waiver. All other terms and conditions of the Policy remain unchanged. SB146932G (10-19) Page 7 of 7 Copyright,CNA All Rights Reserved. CITY OF SANTA ANA Risk Management a division of Human Resources Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE I Renee Escario ("Representative"),attest that I am an authorized (Name and Title of Vendor Representative) representative of RE Consulting ("Company"), and (Consultant/Company Name) possess the authority to legally bind Company. In my capacity as Representative of Company, I represent and confirm the following, as relates to the agreement between Company and City of Santa Ana, agreement number A 2023-194-27 ("Agreement")to provide Environmental Consulting Services ("Services"): (Services to be provided under agreement/contract) During the course and scope of Company's agreement with the City of Santa Ana,Company will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if Company should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, Company shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. If at any time it is found that Company is not adhering to any and/or all of the statements in this document and does not maintain the minimum professional liability insurance coverage as required in the Agreement,it will be considered a breach of Agreement rendering the Agreement null and void and Company will be fully liable for any and all damages. 10/8/2025 Signature Date Renee Escario Print Name President Title Renee@RenvconsuIting.com 949-346-4633 Contact Information,i.e.,Telephone Number and/or Email Address WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANT DOLLARS($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND ATTORNEY'S FEES. Affidavit of Exemption for Workers'Compensation Insurance 11.12.2024 Nguyen, Tu Tran From: PBA Admin Sent: Thursday,January 8, 2026 11:02 AM To: RM D Subject: Request for COI Review(Renee Escario DBA RE Consulting) Attachments: Santa Ana Affidavit of Exemption-Workers' Compensation 1.pdf, 25 (2016-03) Certificate of Liability Insurance.pdf, certificate-2455702-42-202511 261517383401-4B8F939A.pdf, Al Endorsement.pdf Request Type (check only one): ❑ Renewal COI Review- Risk Management will review and approve renewal insurance documents submitted. This applies to PO, E Reservations, Permit, and Agreements. Please attach insurance requirements and previously approved COI(s). All fields required to advance the process-do not delete or modify. City Contact Department: Planning and Building Project Manager Name: Francine Villareal Project Manager Email: FVillarealPsanta-ana.orq Contract Details: Business Name: Renee Escario DBA RE Consulting Agreement Number and Agreement A-2023-194-27 Link: Brief description of services: Provides on-call environmental,technical, and planning services Contractor/Insured Contact 7 Contact Name: Renee Escario Contact Email Address: ReneePrenvconsultinq com 949-346-4633 Contact Phone: Insurance Contact (may be found at top right of the ACORD form) Contact Name: Pavel Yurkov Contact Email Address: sul2portPbizinsure.com Contact Phone: 1-877-900-9998 Additional comment: Broker mentioned the below, is the attached acceptable? 1 F for °our email. L ufortunatl},this polio°does trot offer a 'aiver of 5ubrogatiati etsctorsettiieezt. I apologize fort incon;e e coverage you can reach out to: al Insurance Center. (+628)400-0321 Please feel free to respond with any questions. Best, a�-annah Bizlnsure Support Team 77-900-9995 Thank you, Jacqueline Rivera ' Clerical Aide City of Santa Ana ¢ Planning and Building Agency 20 Civic Center Plaza I Santa Ana,CA 92701 (714)667-2743 1 JRivera5Ca)santa-ana.org City Hall hours are 8 a.m.to 5 p.m.Monday through Thursday,and 8:00 a.m.to 5:00 p.m.every other Friday. Click here for a list of observed holidays and Friday closure dates. 2