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HomeMy WebLinkAboutSHERWOOD HR CONSULTING (SHERWOOD, KANDICE)N-2025-040 INSURANCE NOT REQUIRED WORK MAY PROCEED CITY CLERK DATE: MAR O 5 1015 CONSULTANT AGREEMENT WITH SHERWOOD HR CONSULTING THIS AGREEMENT is made and entered into on this I Oth day of February, 2025 by and between Kandice Sherwood, an individual, doing business as Sherwood HR Consulting, ("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"). H Pry) wgw WnrM tw RECITALS A. The City desires to retain a Consultant having special skill and knowledge in providing training courses on business writing skills, leadership, management, coaching, focus groups and team building. B. To that end, the City issued Request for Proposal No. 24-135 (the "RFP") and Consultant submitted a proposal in response dated December 20, 2024. C. Consultant represents that Consultant is able and willing to provide the specified services from the RFP to the City. 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 consulting 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 Consultant shall perform during the term of this Agreement, the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the services described and set forth in Scope of Services - Exhibit A, attached hereto and incorporated by reference. 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services for City, the rates and charges identified in Compensation - Exhibit B. The total amount to be expended during the term of this Agreement shall not exceed fifty thousand dollars and zero cents ($50,000.00.) Work is performed on an as needed basis and no amount of work is promised or guaranteed pursuant to this Agreement. b. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. City and Consultant agree that all payments due and owing under this Agreement shall be made through Automated Clearing House (ACH) transfers. Consultant agrees to execute the City's standard ACH Vendor Payment Authorization and provide required documentation. Upon verification of the data provided, the City will be authorized to deposit payments directly into Consultant's account(s) with financial institutions. Page 1 of 9 #2018575vl "EMENJI-11-31 This Agreement shall commence on the date first written above for a three year term ending February 9, 2028, with the option for the City to grant up to two, one-year renewals, exercisable by a writing by the City Manager and the City Attorney, unless terminated earlier in accordance with Section 15, below. 4. INDEPENDENT CONSULTANT 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 & 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 A. Minimum Scone and Limit of Insurance: Consultant shall maintain limits of insurance coverage in the following minimum amounts and shall be at least as broad as: 1. 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 and $2,000,000 aggregate. 2. Automobile Liability (AL): Insurance Services Office Form CA 00 01 covering Code 1 (any auto), with combined single limits of $1,000,000. In the event Consultant does Page 2 of 9 #2018575vl not maintain commercial automobile liability insurance, City will accept evidence of personal automobile insurance with existing limits, which can be lower than $1,000,000. 3. Workers' Compensation (W/C): 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, per employee, per policy for bodily injury or disease. This requirement can be waived if Vendor has no employees. If Consultant maintains broader coverage and/or higher limits than the minimums shown above, City requires and shall be entitled to the broader coverage and/or the higher limits maintained by Consultant. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City. B. Other Insurance Provisions: The insurance policies are to contain, or be endorsed to contain, the following provisions: 1. CGL and AL policies: City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers are to be covered as additional insureds with respect to liability arising out of work or operations performed by or on behalf of the Consultant including materials, parts, equipment, and personnel furnished in connection with such work or operations. 2. All required insurance policies: Insurance company(ies) agrees to waive all rights of subrogation against City, its City Council, its officers, officials, employees, agents, and volunteers for losses paid under the terms of any policy which arise from work performed by Consultant for City. 3. All required insurance policies: For any claims related to this Agreement, Consultant's insurance coverage shall be primary and any insurance maintained by City, its City Council, its officers, officials, employees, agents, or volunteers shall not contribute with it. 4. All required insurance policies: A severability of interest provision must apply for all the additional insureds, ensuring that Consultant's insurance shall apply separately to each insured against whom a claim is made or suit is brought, except with respect to the insurer's limits of liability. 5. Each insurance policy required herein shall provide that coverage shall not be canceled, suspended, voided, reduced in coverage or in limits, non -renewed by the carrier, or materially changed except after thirty (30) days prior written notice has been given to City. Ten (10) days prior written shall be provided to City for policy cancellation or non -renewal due to non-payment. 6. Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana, Attention: Human Resources Department, Sofia Style, Organizational and Training Manager), 20 Civic Center Plaza, M-34, Santa Ana, CA 92701. The name and location of event should be included in the Description of Operations section of each certificate, C. Self -Insured Retentions: Self -insured retentions must be declared to and approved by the City. City may require Consultant to purchase coverage with a lower retention or provide Page 3 of 9 #2018575vl proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. D. Acceptability of Insurers: Insurance is to be placed with insurers authorized to conduct business in the state of California with a current A.M. Best rating of no less than A:VII, unless otherwise acceptable to City. E. Verification of Coverage: Consultant shall furnish 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 Entity before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive Consultant's obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. F. Claims Made Policies: If any of the required policies provide coverage on a claims -made basis: 1. The retroactive date must be shown and must be before the date of the Agreement or the beginning of work. 2. Insurance must be maintained and evidence of insurance must be provided for at least three (3) years after completion of work. 3. 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, Company must purchase "extended reporting" coverage for a minimum of three (3) years after completion of work. G. Subcontractors: Consultant shall require and verify that all sub -contractors maintain insurance meeting all the requirements stated herein, and Consultant shall ensure that City is an additional insured on insurance required from sub -contractors. H. 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. llri��u 1►f_L�[N11 Y=[17►1 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, its subcontractors, agents, employees, or other persons acting on its 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 Page 4 of 9 #2018575vl relief is due by reason of the terms 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 terms 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 out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Consultant. 8. INTELLECTUAL PROPERTY INDEMNIFICATION Consultant shall defend and indemnify the City, its officers, agents, representatives, and employees against any and all liability, including costs, for infringement of any United States' letters patent, trademark, or copyright infringement, including costs, 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 trader 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 Page 5 of 9 #2018575v1 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 interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 12. 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. 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, 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 is not embodied herein. III E.I ICWt`I�I�►MY 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 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. Page 6 of 9 #2018575vl 15. 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(s) 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. 16. 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. 17. 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. 18. 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 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. 19. 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 7 of 9 #2018575vl 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 With courtesy copies to: Executive Director, Human Resources Agency City of Santa Ana 20 Civic Center Plaza (M-24) P.O. Box 1988 Santa Ana, California 92702 To Consultant: Ms. Kandice Sherwood Sherwood FIR Consulting 219 Ancona Drive Long Beach, California 90803 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. 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. Page 8 of 9 #2018575vl 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: i .k Laura A. Rossini Chief Assistant City Attorney RECOMMENDED FOR APPROVAL: A�c41� Lori Schnaider Executive Director Human Resources Agency CITY OF SANTA ANA c1� Alvaro Nunez City Manager CONSULTANT: andi Sherwood #2018575v1 Page 9 of 9 EXHIBIT A SCOPE OF SERVICES Sherwood HR Consulting agrees to provide City with any of the following services: • Development of customized training programs/coursework (Curriculum Development). • May include development of training evaluation tools and needs analysis survey, which can be implemented each year to determine needs. • Individual and /or Team Coaching sessions Collaboration and Meetings with the internal staff Includes creating templates for training assignments to standardize curriculum Resources: Sherwood HR Consulting will provide in -person or Zoom account for meetings and a personal laptop for remote programming. For work accomplished on premises, City of Santa Ana will provide meeting rooms, IT support when needed, and all approved training and facilitation materials including purchasing assessments, educational books, videos, training equipment, etc. Sherwood HR Consulting will also be reimbursed for reasonable, necessary and approved expenses incurred by the Consultant on behalf of the City of Santa Ana. Upon termination of the agreement, Sherwood HR Consulting will return to the City of Santa Ana any property, records, documentation, etc. which is the property of the organization. Location and Hours of Work: Services can be conducted remotely or in -person depending on the request; Sherwood HR Consulting will be flexible. Some meeting sessions will be conducted via Zoom; however, in -person meetings on premises will be accommodated as needed/requested. Core hours of work shall occur anytime between the hours of 9:00 a.m. and 5:30 p.m. EXHIBIT B COMPENSATION Activity Rate of Pay/Hours Comments Curriculum Development & $250/hour Time required to develop/re- Customization and/or Needs develop new content or surveys Analysis Survey Development vary depending on content and complexity Training Facilitation $4800 for half day = 1 to 4 Includes set-up and break down. hours $5800 for a full day = 5 to 8 hours Coaching Sessions $250/hour One coaching session is invoiced for two hours (one hour for the coaching session and an additional hour for preparation, documentation, administrative activities such as emails, setting up sessions, etc. ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 03/05/2025 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: BIBERK aIc°No Ext: 844-472-0967 FANo: 203-654-3613 P.O. Box 113247 E-MAIL customerservice@biBERK.com ADDRESS: Stamford, CT 06911 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Berkshire Hathaway Direct Insurance Company 10391 INSURED INSURERB: National Liability & Fire Insurance Company 20052 Kandice Sherwood INSURER C : INSURER D : 219 Ancona Dr INSURER E 7 Belmont Shore, CA 90803 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR PREM SES Ea occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 A X N9BP864109 10/01/2024 10/01/2025 PERSONAL & ADV INJURY $ Included GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOC PRODUCTS - COMP/OPAGG $ 2,000,000 X OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE I I ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Professional Liability (Errors & Omissions): Claims -Made N9PL834219 07/20/2024 07/20/2025 Per Occurrence/ Aggregate 2,000,000/ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of Santa Ana, Attn: Human Resources Department ISAOAATIMA is listed as additional insured as it pertains to general liability. Digitally signed Tu Tran guyenan NAPPROVED Nguyen Ng Uj/2r110:2926-07'001 g Tu Tran Nguyen at 10:28 am, Mar 19, 2025 o:z9:za-mno' Y CERTIFICATE HOLDER CANCELLATION City of Santa Ana, Attn: Human Resources Department ISAOA ATIMA 20 Civic Center Plaza M34 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. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DATE (MM/DD/YYYY) A� " CERTIFICATE OF PROPERTY INSURANCE 03/05/2025 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. PRODUCER CONjACT BIBERK P.O. Box 113247 Stamford, CT 06911 INSURED Kandice Sherwood 219 Ancona Dr Belmont Shore, CA 90803 u/c' No Ext : (844) 472-0967 o/c No): 203 E-M654-3613 ADDRESS' salessu000rtCa)biberk.com INSURER B : INSURER D : INSURER(S) AFFORDING COVERAGE I I INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: NAIC # LOCATION OF PREMISES / DESCRIPTION OF PROPERTY (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Location: 219 Ancona DrBelmont Shore, CA 90803 Bldg #001: Consultants - All Other - 4167702 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 POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) COVERED PROPERTY LIMITS X I PROPERTY OF LOSS DEDUCTIBLES N9BP864109 10/01/2024 10/01/2025 BUILDING PERSONAL PROPERTY BUSINESSINCOME EXTRA EXPENSE RENTAL VALUE BLANKET BUILDING BLANKET PERS PROP BLANKET BLDG & PP $ 0 CAUSES $ 0 BASIC BUILDING 2OONTENTS $ 0 BROAD $ 0 X SPECIAL $ EARTHQUAKE $ n a WIND $ n a FLOOD $ n a INLAND MARINE OF LOSS NAMED PERILS TYPE OF POLICY $ CAUSES $ POLICY NUMBER $ CRIME TYPE OF POLICY $ BOILER & MACHINERY EQUIPMENT BREAKDOWN $ SPECIAL CONDITIONS / OTHER COVERAGES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana, Attn: Human Resources ACCORDANCE WITH THE POLICY PROVISIONS. Department ISAOA ATIMA AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza M34 Santa Ana, CA 92701 ©1995-2015 ACORD CORPORATION. All rights reserved. ACORD 24 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: N9BP864109 BUSINESSOWNERS BP 04 48 01 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Name Of Additional Insured Persons Or Or anization s : City of Santa Ana, Attn: Human Resources Department ISAOA ATIMA Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph C. Who Is An Insured in Section II — Liability: 3. Any person(s) or organization(s) shown in the Schedule is also an additional insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations or in connection with your premises owned by or rented to you. BP 04 48 01 06 © ISO Properties, Inc., 2004 Page 1 of 1 0 Allstate. Jon Lusin Agency 1903 S Main St Santa Ana CA 92707-2827 Information as of February 20, 2025 Policyholder(s) Page 1 of 2 Kandice S Sherwood Policv number 024 349 311 II�II'II�II"I�I"II��'lll�l�''I�'ll'I�III"'ll"�II�II�III�'I'I Your Allstate agency is Jon Lusin Agency KANDICE S SHERWOOD (714) 550-0327 219 ANCONA DR jonlusin@allstate.com LONG BEACH CA 90803-3602 We're confirming your policy change Thank you for choosing Allstate to help protect what's important to you. We've enclosed documents that confirm the policy change(s) you requested. You'll find your coverage details listed on the enclosed amended policy declarations. The following change(s) are effective as of 02/21/2025: Changes to vehicle usage. Your premium for the current policy period has been decreased by a total of $161.48. Your discount savings for this policy period are: $794.22. How to contact us Give your Allstate Agent a call at (714) 550-0327 if you have any questions. It's our pleasure to keep you in good hands. EA120-1 Lit Policy number: 1024349 311 Policy effective date: January 11, 2025 Your Insurance Coverage Checklist Page 2 of 2 We're happy to have you as an Allstate customer! This checklist outlines what's in this package and provides answers to some basic questions, as well as any "next steps" you may need to take. ❑ What's in this package? See the guide below for the documents that are included. Nextsteps: review your Policy Declarations to confirm you have the coverages, coverage limits, premiums and savings that you requested and expected. Read any Endorsements or Important Notices to learn about new policy changes, topics of special interest, as well as required communications. Keep all of these documents with your other important insurance papers. ❑ Am I getting all the discounts I should? Confirm with your Allstate Agent that you're benefiting from all the discounts you're eligible to receive. A guide to your amended package Policy Important Insurance Made Declarations* Notices Simple The Policy We use these Insurance seem Declarations notices to call complicated? lists policy attention to Our online details, such as particularly guides explain your specific important coverage terms drivers, vehicles coverages, policy and features: and coverages. changes and www.allstate.com/ discounts. madesimnle Esnanol.a Ilstate.com /facildeentender ❑ What about my bill? Unless you've already paid your premium in full, we'll send your bill separately. Next steps: please pay the minimum amount by the due date listed on it. You can also pay your bill online at Allstate.com/support or through the Allstate mobile app. If you're enrolled in the Allstate® Easy Pay Plan, we'll send you a statement detailing your payment withdrawal schedule. Para espanol, Ilamar al 1-800-979-4285. ❑ What if I have questions? Visit Allstate.com/support to browse our list of frequently asked questions and find information regarding billing or policy documents. You can also create an online account to access and manage your policies. Para espanol, Ilamar al 1-800-979-4285. * To make it easier to see where you may have gaps in your protection, we've highlighted any coverages you do not have in the Coverage Detail section in the enclosed Policy Declarations. B Amended auto policy declarations Your policy effective date is January 11, 2025 Total Amount Due for the Policy Period WAllstate. Page 1 of 4 Information as of February 20, 2025 Please review your insured vehicles and verify their VI Ns are correct. Summary Vehicles covered Identification Number Premium Named Insured(s) 1990 Nissan JN1RZ26A2LX011623 $844.68 Kandice S Sherwood 2013 Lexus Rx350 JTJZKIBA4D2416668 1,831.52 Mailing address California Fraud Assessment Fee 1.76 219 Ancona Dr Additional coverages 3.45 Long Beach CA 90803-3602 Total* $2,681.41 Policy number 024 349 311 * Your bill will be mailed separately. Before making a payment, please refer to your Your policy provided by latest bill, which includes payment options and installment fee information. if you do Allstate Northbrook Indemnity not pay in full, you will be charged an installment fee(s). Company See the Important payment and coverage information section for details about Policy period installment fees. Beginning January 11, 2025 through July 11, 2025 at 12:01 a.m. standard time Your policy changes are effective DISCOUntS (included in your total premium) February 21, 2025 Good Driver (20%) $651.32 Multiple Policy $136.52 Anti -theft $6.38 Total discounts $794.22 Discounts per vehicle (1990 Nissan $233.87) Good Driver (20%) $193.44 Multiple Policy $40.43 2013 Lexus Rx350 $560,35 Anti -theft $6.38 Good Driver (20%) $457.88 Multiple Policy $96.09 Listed driver on your policy Kandice Sherwood Excluded drivers from your policy None Additional interested party A Certificate of Insurance was sent to: City of Santa Ana 20 Civic Center Plaza M34 Santa Ana, CA 92701-4058 Your Allstate agency is Jon Lusin Agency 1903 S Main St Santa Ana CA 92707-2827 (714)550-0327 jonlusin@allstate.com Some or all of the information on your Policy Declarations is used in the rating of your policy or it could affect your eligibility for certain coverages. Please notify us immediately if you believe that any information on your Policy Declarations is incorrect. We will make corrections once you have notified us, and any resulting rate adjustments, will be made only for the current policy period or for future policy periods. Please also notify us immediately if you believe any coverages are not listed or are inaccurately listed. 0 Amended auto policy declarations Policy number: 1024349 311 Policy effective date: January 11, 2025 Coverage detail for 1990 Nissan Page 2 of 4 Coverage Limits Deductible Premium Automobile Liability Insurance ■ Bodily Injury ■ Property Damage $250,000 each person $500,000 each occurrence $100,000 each occurrence Not applicable $452.61 Auto Collision Insurance Waiver of deductible applies Actual cash value $500 $142.40 Auto Comprehensive Insurance Actual cash value $250 $54.50 Rental Reimbursement Not purchased* Towing and Labor Costs Not purchased* Uninsured Motorists Insurance for Bodily Injury $250,000 each person $500,000 each accident Not applicable $195.17 Automobile Medical Payments Not purchased* Coordinated Medical Protection Not purchased* Sound System Not purchased* Tape Not purchased* Total premium for 1990 Nissan $844.68 * This coverage can provide you with valuable protection. To help you stay current with your insurance needs, contact your Allstate agent to discuss coverage options and other products and services that can help protect you. VIN JN1RZ26A2LX011623 Rating information Your premium is determined based on certain information, including the following: ■ This vehicle is driven for pleasure, rated as an extra vehicle with no assigned operator. Allstate uses mileage information as one factor to help determine your premium amount. Important Note: The annual mileage figure applicable to this vehicle for the expiring policy period was: 2,000 - 2,499. The annual mileage figure applicable to this vehicle for the current policy period is: 3,000 - 3,499. The required odometer information to calculate your annual mileage for the current policy period was not provided, was illegible, could not be obtained or the most recent odometer reading we received was less than a previous reading. If any of the information shown above is incorrect, missing or changes in the future, please contact your Allstate representative. Please keep in mind that a change in any of the information may result in an adjustment to your premium. Amended auto policy declarations Policy number: 1024 349 3 11 Policy effective date: January 11, 2025 Coverage detail for 2013 Lexus Rx350 Page 3 of 4 WAllstate. Coverage Limits Deductible Premium Automobile Liability Insurance ■ Bodily Injury ■ Property Damage $250,000 each person $500,000 each occurrence $100,000 each occurrence Not applicable $804.60 Auto Collision Insurance Waiver of deductible applies Actual cash value $500 $388.84 Auto Comprehensive Insurance Actual cash value $250 $121.14 Rental Reimbursement Not purchased* Towing and Labor Costs Not purchased* Uninsured Motorists Insurance for Bodily Injury $250,000 each person $500,000 each accident Not applicable $516.94 Automobile Medical Payments Not purchased* Coordinated Medical Protection Not purchased* Sound System Not purchased* Tape Not purchased* Total premium for 2013 Lexus Rx350 $1,831.52 * This coverage can provide you with valuable protection. To help you stay current with your insurance needs, contact your Allstate agent to discuss coverage options and other products and services that can help protect you. VIN JTJZKIBA4D2416668 Rating information Your premium is determined based on certain information, including the following: ■ This vehicle is driven 3-9 miles to work/school, widowed person licensed 46 years. Allstate uses mileage information as one factor to help determine your premium amount. Important Note: The annual mileage figure applicable to this vehicle for the expiring policy period was: 50,000 or more. The annual mileage figure applicable to this vehicle for the current policy period is: 50,000 or more If any of the information shown above is incorrect, missing or changes in the future, please contact your Allstate representative. Please keep in mind that a change in any of the information may result in an adjustment to your premium. Additional coverages The following policy coverages are also provided. Coverage Limits Deductible Premium Automobile Death Indemnity Insurance $2.04 ■ Named Insured $15,000 benefit Not applicable a (continued) o u E Amended auto policy declarations Policy number: 1024349 311 Policy effective date: January 11, 2025 Page 4 of 4 Coverage Limits Deductible Premium Automobile Disability Income Protection $1.41 ■ Named Insured $50 weekly indemnity Not applicable Identity Theft Expenses Not purchased* Total $3.45 * This coverage can provide you with valuable protection. To help you stay current with your insurance needs, contact your Allstate agent to discuss coverage options and other products and services that can help protect you. Your policy documents Your automobile policy consists of this Policy Declarations and the documents in the following list. Please keep these together. ■ Allstate Automobile Policy - AU104-3 ■ Additional Interest Endorsement (Notice of Policy Cancellation or Change) - AU2334 ■ Amendment of Policy Provisions - AU14626-1 ■ California Paperless Disclosure - AU14943 ■ California Amendatory Endorsement - AU14629-3 Important payment and coverage information Here is some additional, helpful information related to your coverage and paying your bill: ►Your rate is lower because you are insuring multiple cars. ►Your bill will be sent to you in a separate mailing and will list any payment option(s) available to you. If you are eligible to pay your premium in installments, your first/renewal bill will reflect your available payment options, including the option to pay in full or to pay in monthly installments. If you decide to pay your premium in installments, there will be a $3.50 installment fee charge for each payment due. If you make 5 installment payments during the policy period, and do not change your payment plan method, then the total amount of installment fees during the policy period will be $17.50. If you are on the Allstate® Easy Pay Plan, there will be a $1.00 installment fee charge for each payment due. If you make 5 installment payments during the policy period, and remain on the Allstate® Easy Pay Plan, then the total amount of installment fees during the policy period will be $5.00. If you change payment plan methods or make additional payments, your installment fee charge for each payment due and the total amount of installment fees during the policy period may change or even increase. Please note that the Allstate® Easy Pay Plan allows you to have your insurance payments automatically deducted from your checking or savings account. Allstate Northbrook Indemnity Company's Secretary and President have signed this policy with legal authority at Northbrook, Illinois. X J4&� &&- Phil Telgenhoff Courtney Welton President Secretary Important notices Policy number: 1024349 311 Policy effective date: January 11, 2025 Page 1 of 1 WAllstate. You've recently made a change to your Please contact your Allstate Agent or representative at the number on the top of this page, or chat with us at policy allstate.com/help. The State of California recently passed Assembly Bill 1511, which requires insurers to provide the following statement when you've made a change to your policy: "For your protection, California law requires the following to appear on this form: Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison." Have questions? Please contact us. If you have any questions regarding this information or your insurance coverage in general, please feel free to contact your Allstate Agent or representative. X74018 Important info on minor traffic violation(s) while driving for commercial use Your personal automobile insurance premium may not be increased if you receive a minor traffic violation while driving for commercial use, as defined by California Insurance Code 488. What is driving for commercial use? To be eligible, you must be driving for commercial use as defined by California Insurance Code 488: • Individuals whose specific job duties involve driving their employer's motor vehicles (not their own personal vehicle); or • Individuals who have authority in their name from the Public Utilities Commission to operate as a traffic carrier and who are the registered owners or lease operators of the motor vehicle used in the operation as a highway carrier What you have to do: If you received a minor traffic violation while driving for commercial use, please contact your Allstate Agent or representative to complete a signed declaration form. Please note: this declaration is made under the penalty of perjury. Questions? We're here to help. X74284 CITY OF SANTA ANA Risk Management a division of Human Resources Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE Kandice Sherwood, Owner/Senior Consultant (Name and Title of Vendor Representative) ("Representative"), attest that I am an authorized representative of Sherwood HR Consulting (SHRC) (Consultant/Company Name) possess the authority to legally bind Company. ("Company"), and 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 ("Agreement") to provide Coaching, Training, Content development (Services to be provided under agreement/contract) ("Services"): 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. Signature Kandice Sherwood Owner/Senior Consultant 5622080150 Print Name Title Contact Information, i.e., Telephone Number and/or Email Address 2/26/2025 Date 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 ACOR"® CERTIFICATE OF LIABILITY INSURANCE Fil/06/2025DATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: BIBERK aIc°No Ext: 844-472-0967 FA No: 203-654-3613 P.O. Box 113247 E-MAIL customerservice@biBERK.com Stamford, CT 06911 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Berkshire Hathaway Direct Insurance Company 10391 INSURED INSURER B: Kandice Sherwood INSURER C: 219 Ancona Dr INSURER D: Belmont Shore, CA 90803 INSURER E 7 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 INSD WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 RENTED CLAIMS-MADE OCCUR PREM SES Ea occurrence) $ 50,000 A N9BP943281 10/01/2025 10/01/2026 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ Included GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 X OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I I ER ANYPROPRIETOR/PARTNER/EXECUTIVE 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 $ Professional Liability (Errors & Per Occurrence/ Omissions): Claims-Made Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) City of Santa Ana, Attn: Human Resources Department ISAOAATIMA is listed as additional insured as it pertains to general liability. Digitally signed TU Tran by Tu Tran Nguyen Nguyen 1 Date:30-08 00 6 APPROVED By Tu Tran Nguyen at 2:42 pm,Nov 06,2025 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana. Attention, Human Resources Depa 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 DATE(MM/DD/YYYY) A�" CERTIFICATE OF PROPERTY INSURANCE 11/06/2025 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. PRODUCER CONTACT NAME: IC ICC o Ext: (844) 472-0967 a/c No): 203 654-3613 BIBERK ADODRESS: salessupport@biberk.com P.O. Box 113247 PRODUCER CUSTOMER ID: Stamford, CT 06911 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA:Berkshire Hathaway Direct Insurance Com al 541611 INSURER B: Kandice Sherwood INSURER C7 219 Ancona Dr Belmont Shore, CA 90803 INSURER D 7 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: LOCATION OF PREMISES/DESCRIPTION OF PROPERTY (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Location: 219 Ancona DrBelmont Shore, CA 90803 Bldg #001: Consultants- All Other- 4167702 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 POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION COVERED PROPERTY LIMITS LTR DATE(MM/DD/YYYY) DATE(MM/DD/YYYY) X PROPERTY BUILDING $ 0 CAUSES OF LOSS DEDUCTIBLES PERSONAL PROPERTY $ 0 BASIC BUILDING N9BP943281 10/01/2025 10/01/2026 BUSINESSINCOME $ 0 BROAD 2OONTENTS EXTRA EXPENSE $ 0 X SPECIAL RENTAL VALUE $ EARTHQUAKE BLANKET BUILDING $ n a WIND BLANKET PERS PROP $ n a FLOOD BLANKET BLDG&PP $ n a INLAND MARINE TYPE OF POLICY $ CAUSES OF LOSS $ NAMED PERILS POLICY NUMBER $ CRIME TYPE OF POLICY $ BOILER&MACHINERY $ EQUIPMENT BREAKDOWN SPECIAL CONDITIONS/OTHER COVERAGES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Santa Ana. Attention, Human Resources Departme ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE ©1995-2015 ACORD CORPORATION. All rights reserved. ACORD 24(2016/03) The ACORD name and logo are registered marks of ACORD BUSINESSOWNER'S POLICY 2. Premium shown in this policy as advance pre- L. Transfer Of Your Rights And Duties Under This mium is a deposit premium only. At the close of Policy each audit period we will compute the earned premium for that period and send notice to the Your rights and duties under this policy may not be first Named Insured. The due date for audit transferred without our written consent except in premiums is the date shown as the due date the case of death of an individual Named Insured. on the bill. If the sum of the advance and audit If you die, your rights and duties will be transferred premiums paid for the policy period is greater to your legal representative but only while acting than the earned premium, we will return the within the scope of duties as your legal represen- excess to the first Named Insured. tative. Until your legal representative is appointed, 3. The first Named Insured must keep records of anyone having proper temporary custody of your the information we need for premium computa- property will have your rights and duties but only tion, and send us copies at such times as we with respect to that property. may request. K. Transfer Of Rights Of Recovery Against Others To Us 1. Applicable to Businessowners Property Cover- age: If any person or organization to or for whom we make payment under this policy has rights to recover damages from another, those rights are transferred to us to the extent of our pay- ment. That person or organization must do everything necessary to secure our rights and must do nothing after loss to impair them. But you may waive your rights against another party in writing: a. Prior to a loss to your Covered Property. b. After a loss to your Covered Property only if, at time of loss, that party is one of the fol- lowing: (1) Someone insured by this insurance; (2) A business firm: (a) Owned or controlled by you; or (b) That owns or controls you; or (3) Your tenant. You may also accept the usual bills of lading or shipping receipts limiting the liability of carriers. This will not restrict your insurance. 2. Applicable to Businessowners Liability Cover- age: If the insured has rights to recover all or part of any payment we have made under this policy, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. This condition does not apply to Medical Expenses Coverage. Page 48 of 48 Includes copyrighted material of the Insurance Services Office, Inc.,used with its permission. BP 00 03 01 10 POLICY NUMBER: N9BP943281 BUSINESSOWNERS BP 04 48 01 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Name Of Additional Insured Persons Or Or anization s : City of Santa Ana, Attn: Human Resources Department ISAOA ATIMA Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph C. Who Is An Insured in Section II— Liability: 3. Any person(s) or organization(s) shown in the Schedule is also an additional insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations or in connection with your premises owned by or rented to you. BP 04 48 01 06 © ISO Properties, Inc., 2004 Page 1 of 1 0 Thank you for choosing Allstate WAllstate. Proof of Insurance Card Page 1 of 2 For your convenience,two insurance cards have been included for each vehicle.State law requires that one of these cards be kept in each vehicle.Please place them in your vehicles by the effective date. .......................................................................................................................................................................................................................... Allstate. : Allstate. Please use the printed Insurance Cards below. Please use the printed Insurance Cards below. ................................................................................................<.......------.......................................................................................................: Allstate., Allstate. Please use the printed Insurance Cards below. Please use the printed Insurance Cards below. ..................................................................................................................................................................................................................... . . . California Evidence Allstate. Callfornia Evidence Allstate of Liability Insurance of Liability Insurance Allstate Northbrook Indemn�y Company NAIC#36455 Allstate Northbrook Indemnity Compa NAIC#36455 PO Box 660598,Dallas,TX 75266-0598 PO Box 660599,Dallas,TX 75266-0597 Kandce S Sherwood Kandlce S Sherwood 219 Ancona Dr 219 Ancona Dr Long Beach CA 90803-3602 Long Beads CA 90803-3602 This policy complies with Sections 16056 or 16500.5 of the This policy complies with Sections 16056 or 16500,5 of the Callfornia Vehicle Code. Callfornia Vehicle Code. POLICY NUMBER YEAR/MAKE/MODEL i POLICY NUMBER YEAR/MAKE/MODEL 024 349 311 2013 Lexus Rx350 024 349 311 2013 Law Rx350 EFFECTIVE DATE 07/11/25 VEHICLE ID NUMBER EFFECTIVE DATE 07/11/25 VEHICLE ID NUMBER EXPIRATION DATE 01/11/26 JTJZKIBA4D2416668 EXPIRATION DATE 01/11/26 JTJZKIBA4D2416668 Evidence of financial responsibility shall at all times be carried in the vehicle. Evidence of financial responsibility shall at oil times be carried in the vehicle. Insurance nformation has already been submitted directlyto the DMV i Insurance Information has already been submitted directly to the DMV electronically,submit this document to DMV only if specifcally requested by ; �electronicaliy,submit this document to DMV only if specifically requested by 2013 Lexus Rx350 DMV. $386.37 notify us immediately if you believe that any information on your Policy Anti-theft $ Good Driver(20%) $315.99 Declarations is incorrect.We will make Multiple Policy $66.66.24 corrections once you have notified us, and any resulting rate adjustments,will Listed driver on your policy be made only for the current policy Kandice Sherwood period or for future policy periods. Please also notify us immediately if you believe any coverages are not listed or Excluded drivers from your policy are inaccurately listed. None ' Additional interested party A Certificate of Insurance was sent to: City of Santa Ana 20 Civic Center Plaza M34 Renewal auto policy declarations Page 2 of 5 Policy number: 1024349 311 Policy effective date: July 11, 2025 Coverage detail for 1990 Nissan Coverage Limits Deductible Premium -------- -------- Automobile Liability Insurance Not applicable $492.59 • Bodily Injury $250,000 each person $500,000 each occurrence • Property Damage_ $100,000 each occurrence Auto Collision Insurance Actual cash value $500 $142.40 Waiver of deductible applies _ Auto Comprehensive Insurance Actual cash value $250 $59,51 Rental Reimbursement _ Not purchased* Towing and Labor Costs Not purchased* Uninsured Motorists Insurance for Bodily $250,000 each person Not applicable $218.41 Injury $500,000 each accident Automobile Medical Payments Not purchased* Coordinated Medical Protection Not purchased* Sound System Not purchased* Tape Not purchased* Total premium for 1990 Nissan $912.91 *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. VIN JN1RZ26A2LX011623 Rating information Your premium is determined based on certain information, including the following: • This vehicle is driven for pleasure, rated as an extra vehicle with no assigned operator. Allstate uses mileage information as one factor to help determine your premium amount. Important Note:The annual mileage figure applicable to this vehicle for the expiring policy period was:3,000-3,499.The annual mileage figure applicable to this vehicle for the current policy period is:3,000-3,499. The required odometer information to calculate your annual mileage for the current policy period was not provided,was illegible,could not be obtained or the most recent odometer reading we received was less than a previous reading. M If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate representative. Please keep in mind that a change in any of the information may result in an adjustment to your premium. Q N tV �RnS T Q o p O O F 4 Renewal auto policy declarations Policy number: 1024 349 311 Page 3 of 5 WAllstate. Policy effective date: July 11, 2025 Coverage detail for 2013 Lexus Rx350 Coverage Limits Deductible Premium Automobile Liability Insurance Not applicable $625.16 • Bodily Injury $250,000 each person $500,000 each occurrence • Property Damage $100,000 each occurrence Auto Collision Insurance Actual cash value $500 $233,08 Waiver of deductible applies _ Auto Comprehensive Insurance Actual cash value $250 $78.56 Rental Reimbursement Not purchased* Towing and Labor Costs Not purchased* Uninsured Motorists Insurance for Bodily $250,000 each person Not applicable $327.13 Injury $500,000 each accident Automobile Medical Payments Not purchased* _ Coordinated Medical Protection Not purchased* Sound System Not purchased* _ Tape Not purchased* :a Total premium for 2013 Lexus Rx350 $1,263.93 *This coverage can provide you with valuable protection. To help you stay +!" current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. VIN JTJZK1BA4D2416668 Rating information Your premium is determined based on certain information, including the following: • This vehicle is driven 3-9 miles to work/school, widowed person licensed 47 years. Allstate uses mileage information as one factor to help determine your premium amount. Important Note:The annual mileage figure applicable to this vehicle for the expiring policy period was:50,000 or more.The annual mileage figure applicable to this vehicle for the current policy period is:50,000 or more If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate representative.Please keep in mind that a change in any of the information may result in an adjustment to your premium. Additional coverages The following policy coverages are also provided. Coverage Limits Deductible Premium Automobile Death Indemnity Insurance $1.92 • Named Insured $15,000 benefit Not applicable (continued) Renewal auto policy declarations Policy number: 1024 349 311 QA11state- Policy effective date: July 11, 2025 Page 5 of 5 Allstate Northbrook Indemnity Company's Secretary and President have signed this policy with legal authority at Northbrook, Illinois. x &*� &lq— Phil Telgenhoff Courtney Welton President Secretary ial Renewal auto policy declarations Page 4 of 5 Policy number: 1024349 311 Policy effective date: July 11, 2025 Coverage Limits Deductible Premium Automobile Disability Income Protection $1.33 - Named Insured $50 weekly indemnity Not applicable Identity Theft Expenses Not purchased* Total $3.25 *This coverage can provide you with valuable protection. To help you stay current with your Insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. Your policy documents Your automobile policy consists of this Policy Declarations and the documents in the following list. Please keep these together. Allstate Automobile Policy-AU104-3 - Additional Interest Endorsement(Notice of Policy Cancellation or Change)-AU2334 - Amendment of Policy Provisions-AU14626-1 - California Paperless Disclosure-AU14943 - California Amendatory Endorsement-AU14629-3 Important payment and coverage information Here is some additional, helpful information related to your coverage and paying your bill: ►If we cancel or non-renew your policy,a copy of the notice of cancellation will be sent to all listed drivers on the policy. ►Your rate is lower because you are insuring multiple cars. ►Your bill will be sent to you in a separate mailing and will list any payment option(s)available to you. If you are eligible to pay your premium in installments,your first/renewal bill will reflect your available payment options, including the option to pay in full or to pay in monthly installments. If you decide to pay your premium in installments,there will be a$3.50 installment fee charge for each payment due. If you make 5 installment payments during the policy period, and do not change your payment plan method,then the total amount of installment fees during the policy period will be$17,50. , If you are on the Allstated Easy Pay Plan,there will be a$1.00 installment fee charge for each payment due. If you make 6 installment payments during the policy period, and remain on the Allstate*Easy Pay Plan,then the total amount of installment fees during the policy period will be$6.00. M If you are on the Recurring Credit Card Plan,there will be a$3,50 installment fee charge for each payment due. If you make 6 installment payments during the policy period, and do not change your payment plan method,then the total amount of 8 installment fees during the policy period will be$21,00. If you change payment plan methods or make additional payments,your installment fee charge for each payment due and the ;r' Q total amount of installment fees during the policy period may change or even increase. a N n Please note that the Allstatea Easy Pay Plan allows you to have your insurance payments automatically deducted from your checking or savings account. o&! a Important notices Policy number: 1024 349 311 Page 2 of 3 WAllstate. Policy effective date: July 11, 2025 If the problem remains unresolved,you may contact the X73372-1 California Department of Insurance at: Consumer Services Division Discount for Anti-Theft Devices California Department of Insurance 300 South Spring Street,Los Angeles,CA 90013 We have some good news for you regarding your Allstate Consumer Hotline: 1.800-927-4357 Northbrook Indemnity Company policy. Website: http://ign-m.insurance.ca.gov/01.-consumersZ101-help/index Based on the information we have on file for your insured .cfm vehicle,you may be eligible to receive Allstate's Anti-Theft Please contact the Department of Insurance only if you have Device Discount on your auto policy.This discount provides been unable to satisfactorily resolve the problem with your additional savings on your insurance bill if your auto has a Allstate representative and with Allstate. qualifying anti-theft device. X5126.4 To see if you qualify for a discount,we need to confirm some information about your insured vehicle.As a result,we ask that you please contact your Allstate agent at your earliest We Have Adjusted Your Annual Mileage convenience.You can also call us directly at 1-800-ALLSTATE Amount (1-800-255-7828). Thank you for choosing Allstate.We appreciate your business. As you may know,Allstate considers many factors when X73402 �r{I determining the auto premiums of our customers.One of these factors is the annual mileage of the vehicles we insure. Your Annual Mileage Voluntary Provider Networks We previously sent you a questionnaire that included a request We want to let you know about a program that may be for odometer readings for all of the insured vehicles on your available to you. policy.We recently received your completed questionnaire with this information, but the odometer reading listed on the If you,or anyone covered under your policy, is injured in a loss form for one or more of your vehicles is either illegible or less covered under your auto policy, a Voluntary Provider Network than a previous odometer reading we have on file. may be available to you.A Voluntary Provider Network Because of this discrepancy,we could not determine your includes a variety of participating medical providers that can annual mileage information for the current policy treat those injuries. g p y period.As a result,we may have attempted to obtain your vehicle's Voluntary Provider Networks maintain lists of their odometer information from a third-party vendor. If this participating providers. In the event that you experience a loss, information was available,we used it to determine your annual your claims representative can provide you with contact _ mileage and rate your policy accordingly. If your vehicle's information for any participating Allstate networks that may be odometer information was not available from this vendor,we available in your state at that time. may have increased your annual mileage amount by 1,000 You are under no obligation to use a medical provider who is a miles and rated your policy accordingly. Please refer to the member of one of these networks, and you are free to seek "Rating Information"section of the enclosed Policy medical services from a provider of your choice.There is no Declarations for any changes to your mileage information. penalty if you choose a provider outside the network. If you are Have Questions?Please Contact Us injured and treated by a provider who is a member of one of the Please contact your Allstate Agent to provide a current participating networks,we may review their bills for covered odometer reading for your insured vehicle(s).When we receive medical services for re-pricing based on the approved rate for this information,we will update your annual mileage amount that provider's network. based on the reading you provide, and, if necessary,adjust You do not need to make a choice about these networks at this your overall premium.Your agent can also answer any time.Please keep in mind that using a provider within a questions you may have about the information in this notice. network should not be considered a confirmation that you have Thank you for choosing Allstate. coverage.This notice is for informational purposes only. Important notices Page 3 of 3 Policy number: 1024349311 Policy effective date: July 11, 2025 X73469 operators of the motor vehicle used in the operation as a highway carrier Important information about the Good What you have to do: If you received a minor traffic violation while driving for Driver Discount commercial use, please contact your Allstate Agent or representative to complete a signed declaration form.Please The Good Driver Discount gives a driver the opportunity to note:this declaration is made under the penalty of perjury, receive a discount for having a good driving history. Questions?We're here to help. Depending on your driving experience and information in your Please contact your Allstate Agent or representative at the driving record, (such as the number of traffic violation number on the top of this page,or chat with us at convictions or accidents),you could be eligible for a 20% allstate.com/help. discount on your auto insurance premiums. X74284 Please Note:If a driver is no longer eligible for a Good Driver Discount policy because of the driving safety record or years of driving experience of any other person,the good driver is eligible to purchase a Good Driver Discount policy which excludes such other persons from coverage. If you want to exclude such other persons from your auto policy so that Allstate can offer you the Good Driver Discount policy, please contact your Allstate agent or representative.This change may affect your premium and any discounts currently on your policy. Questions? If you think you may qualify, have any questions regarding the Good Driver Discount or your coverage in general, please feel free to contact your Allstate agent or representative. X73866 Important info on minor traffic violation(s) while driving for commercial use Your personal automobile insurance premium may not be increased if you receive a minor traffic violation while driving for commercial use,as defined by California Insurance Code 488. What Is driving for commercial use? To be eligible,you must be driving for commercial use as $ defined by California Insurance Code 488: $ • Individuals whose specific job duties involve driving a$ their employer's motor vehicles(not their own N personal vehicle);or • Individuals who have authority in their name from the Public Utilities Commission to operate as a traffic carrier and who are the registered owners or lease Q� o� �a Policy number: 1024 349 311 Policy effective date: July 11, 2025 WAllstate. Allstate Has Discounts Available on Improvement Course approved by the California Department of Motor Vehicles may qualify for a 5%discount on some Your Auto Premium coverages. In order to be eligible,the driver must have voluntarily attended the course.This discount will be applied We have several discounts available to our auto insurance for three years after successful completion of the course; in customers.For your information, here is a listing of our order to continue to receive the discount after this three-year discounts, including a brief description of each. (Certain period,the course must again be successfully completed and rating information and any discounts that you're currently proof presented. receiving are shown on the enclosed Policy Declarations.) Anti-Theft Device Discount—You may be eligible to receive Distinguished Driver Discount—The Distinguished Driver a discount on your comprehensive coverage if you have a Discount applies to most major auto coverages.To qualify, qualifying anti-theft device installed on your car. the rated operator on a vehicle must meet certain requirements, including those explained below: Occasional Operator Discount—You may be eligible to - • For the past three years,the rated operator must have receive a discount on most major auto coverages if the rated been licensed to drive a motor vehicle; operator on a vehicle has been licensed for less than nine • The rated operator has had no traffic violation years and has 25%or less use of the vehicle. convictions for the past three years;and Good Student Discount—You may be eligible to receive a • The rated operator has remained accident-free for the discount on most major auto coverages if you have an past five years, or has been less than 51%at fault in any unmarried driver on your policy who is a full-time student .r;,.. accident that has occurred during the past five years and (high school, college,or academic home study program)and for which no claim payment was made. meets certain scholastic and other requirements. In addition, rated operators that have had no traffic violation teenSMARTTTM Discount—You may be eligible to receive a .1 convictions or accidents for even longer consecutive time discount on most major auto coverages if you have a rated periods may qualify for an even larger Distinguished Driver operator who is single, has been licensed five years or less, Discount amount. and completes the teenSMARTTM program.The The Distinguished Driver Discount is applied on a per vehicle teenSMARTT"°program is a home study driver trainingprogram designed to help reduce the chances of your young a basis. Therefore, if a vehicle does not have an assigned driver being involved in an accident.Successfully completing operator,the Distinguished Driver Discount will apply only if the program can earn a discount of up to 15%on most major o all operators in the household qualify for the Distinguished coverages provided by your auto policy. Driver Discount. Multiple Policy Discount—You may qualify for a discount on Other Rating Factors—In addition to the discounts described most major auto coverages if you or your spouse or above,we offer a number of special rates that can lower your registered domestic partner are also the named insured on a premium, For example,you may be eligible to receive a lower qualifying Allstate Insurance Company Homeowners, rate if your insured auto(model year 2000 or earlier)is on - Condominium Owners, Mobile Home Owners, or Renters our list of"economy cars.' , Ask your Allstate Agent for details policy that covers the principal place of residence. If you or about our special rates. your spouse or registered domestic partner are the named The premium for your insurance policy is based on a variety insured on a qualifying Allstate individual life insurance policy of factors, including information you have given us.Factors written prior to October 11,2021, or Allstate Personal that can affect your premium include,for example,annual Umbrella Policy,you may qualify for a discount on most of mileage driven,years of licensed driving experience and your major auto coverages. driving record. It is important that you notify us if the Good Driver Discount—Depending on your driving information upon which your premium is based is incorrect, experience and information in your driving record,such as incomplete,or changes,so that we may adjust your premium the number of traffic violation convictions or accidents,you accordingly, could be eligible for a 20%discount on your auto insurance This notice provides only a general description of the premiums. qualifications and conditions for the discounts and special Defensive Driver Discount—Drivers age 55 or older who rates shown above.Other qualifications and conditions may provide proof of successful completion of a Mature Driver apply. For complete details on qualifications and conditions, Policy number: 1024 349 311 Policy effective date: July 11, 2025 how your premium is determined,or if you have any questions about the information in this notice, including whether you may qualify for one or more discounts or special rates or whether your premium is accurate, please call your Allstate Agent. X73951.2 a �q QQN O. Nn n o . number: 1024 349 31:1] Page 2 of 2 ,,icy effective date: July 11, 2025 . ....... ............. . .......... ....... ........... ..... ....................................................................................... ......... ..................... Please use the printed Insurance Cords below. Please use the printed Insurance Cards below. .......................................................................................... Please use the printed Insurance Cords below. Please use the printed Insurance Cords below. ....................... ............................................................... .............................................................................................................................................. If you have an accident or loss: If you have an accident or loss: # Get medical attention if needed. - Get medical attention if needed. , Notify the police immediately, * Notify the police immediately, - Obtain names,addresses,phone numbers(work&home)and * Obtain names,addresses,phone numbers(work&home)and license plate numbers of all persons involved,including license plate numbers of all persons involved,including passengers and witnesses, passengers and witnesses, Call 1-800-ALLSTATE 0-800-255-7828), • Call 1-800-ALLSTATE 0-800-255-7828), logon to allstate.com or contact your Allstate agent logon to allstate,com or contact your Allstate agent as soon as possible, as soon as possible. Jon Lusin Agency Jon Lusin Agency (714)550-0327 (714)550-0327 1903 S Main St 1903 S Main St 6 Santa Ana,CA 92707-2827 Santa Ana,CA 92707-2827 Renewal auto policy declarations Q)Allstate. Your policy effective date is January 11,2026 Page 1 of 4 Information as of December 5, 2025 Total Amount Due for the Policy Period Please review your insured vehicles and verify their VINs are correct. Summary Vehicles covered Identification Number Premium Named Insured(s) 1990 Nissan JN1RZ26A2LX011623 $912.91 Kandice S Sherwood 2013 Lexus Rx350 1TJZK1BA4D2416668 1,263.93 Mailing address California Fraud Assessment Fee 1.76 219 Ancona Dr Additional coverages 3.25 Long Beach CA 90803.3602 Total* $2,181.85 Policynumber 024 349 311 *Your bill will be mailed separately.Before making a payment,please refer to your Your policy provided by latest bill,which Includes payment options and installment fee information.If you do Allstate Northbrook Indemnity not pay In full,you will be charged an installment fee(s). Company See the Important payment and coverage information section for details about Policy period installment fees. Beginning January 11,2026 through July 11,2026 at 12:01 a.m.standard time Discounts (included in your total premium) Your Allstate agency is Jon Lusin Agency Good Driver(20%) $526.51 Multiple Policy $110.28 1903 S Main St Anti-theft $4.14 Santa Ana CA 92707-2827 To"discounts $640.93 (714)550-0327 Some or all of the information on your Discounts per vehicle Policy Declarations is used in the rating of your policy or it could affect your 1990 Nissan $254.56 eligibility for certain coverages.Please Good Driver(20%) $210.52 Multiple Policy $44.04 notify us immediately if you believe that 2013 Lexus Rx350 $386.37 any information on your Policy Anti-theft $4.14 Good Driver(20%) $315.99 Declarations is incorrect.We will make Multiple Policy $66.24 corrections once you have notified us, and any resulting rate adjustments,will Listed driver on your policy be made only for the current policy Kandice Sherwood period or for future policy periods. Please also notify us immediately if you believe any coverages are not listed or Excluded drivers from your policy are Inaccurately listed. None Additional interested party APPROVED A Certificate of Insurance was sent to: City of Santa Ana By Tu Tran Nguyen at 4:10 pm,May 11,2026 20 Civic Center Plaza M34 Santa Ana, CA 92701-4058 Renewal auto policy declarations Page 2 of 4 Policy number; 1024 349 311 Policy effective date: January 11, 2026 Coverage detail for 1990 Nissan Coverage Limits Deductible Premium Automobile Liability Insurance Not applicable $492.59 • Bodily Injury $250,000 each person $500,000 each occurrence • Property Damage _ $100,000 each occurrence Auto Collision Insurance Actual cash value $500 $142.40 _Waiver of deductible applies Auto Comprehensive Insurance Actual cash value _ $250 $59.51 Rental Reimbursement Not purchased* _ Towing and Labor Costs Not purchased* Uninsured Motorists Insurance for Bodily $250,000 each person Not applicable $218.41 Injury $500,000 each accident Automobile Medical Payments _ Not purchased* Coordinated Medical Protection Not purchased* _ Sound System Not purchased* Tape Not purchased* Total premium for 1990 Nissan $912.91 *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. VIN JN1RZ26A2LX011623 Rating information Your premium is determined based on certain information, including the following: • This vehicle is driven for pleasure, rated as an extra vehicle with no assigned operator. • The number of miles that this vehicle is driven annually is 3,000-3,499.and was previously 3,000- s 3,499. If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate representative. Please keep in mind that a change In any of the information may result in an adjustment to your premium. 5 0 Coverage detail for 2013 lexus Rx350 Coverage Limits Deductible Premium y Automobile Liability Insurance Not applicable $625.16 • Bodily Injury $250,000 each person a S $500,000 each occurrence • Property Damage $100,000 each occurrence Auto Collision Insurance Actual cash value $500 $233.08 0 0 Waiver of deductible applies $o a (continued) 6 n U7 N N O V N 8a O N (_y H X Q Renewal auto policy declarations A I I state Policy number: 024 349 311 Page 3 of 4 Policy effective date: January 11, 2026 Coverage Limits Deductible Premium Auto Comprehensive Insurance Actual cash value $250 $78.56 Rental Reimbursement Not purchased* Towing and Labor Costs Not purchased* Uninsured Motorists Insurance for Bodily $250,000 each person Not applicable $327.13 Injury $500,000 each accident Automobile Medical Payments Not purchased* Coordinated Medical Protection Not purchased* Sound System Not purchased* Tape Not purchased* Total premium for 2013 Lexus Rx350 $1,263.93 *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. VIN JTJZKIBA4D2416668 Rating information Your premium is determined based on certain :l information, including the following: ' • This vehicle is driven 3-9 miles to work/school, ' widowed person licensed 47 years. • The number of miles that this vehicle is driven annually is 50,000 or more and was previously 50,000 or more. If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate representative. Please keep in mind that a change in any of the information may result in an adjustment to your premium. Additional coverages The following policy coverages are also provided. Coverage Limits Deductible Premium Automobile Death Indemnity Insurance $1.92 • Named Insured $15,000 benefit Not applicable Automobile Disability Income Protection $1.33 • Named Insured $50 weekly indemnity Not applicable Identity Theft Expenses Not purchased* Total $3.25 *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you.