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ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DDmYY) `� 07/1712019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, 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 Tolman 8 Wiker Insurance Services LLC #OE52073 196 S. Fir Street CONTACT Nikki Raunsbak, CISR, AINS NAME: R/CNN E (805) 585-6172 Ba : (805) 585-6272 AooaEss. nmunsbak@tolmanandwikeccom PO BOX 1388 Ventura CA 93002-1388 INSURER(S) AFFORDING COVERAGE NAIC a INSURERA: Ohio Security Ins Co 24082 INSURED INSURER B: Employers Preferred Ins Co 10346 Shaw HR Consulting, Inc. INSURER C: AXIS Ins Co 37273 107 N. Raino Rd., #414 INSURER O: INSURER E: Newbury Park CA 9132D INSURER F: UUVLKAUES CERTIFICATE NUMBER: uevHU11HINUA/Wt:19120 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. N LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER tPOW0YEFF MMIDDIYYYY) IMMIDUIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1.000,000 MSES Eaeccueance g 500,000 CLAIMS -MADE 7x OCCUR MED EXP An . ) S 15,000 PERSONAL$ADV INJURY $ 1,000,000 A Y BKW 2058447520 04/01/2019 04/01/2020 GEN-MGREGATE LIMITAPPLIES PER: GENERALAGGREGATE S 2.ODO,000 PRO POLICYJECT LOC PRODUCTS-COMP/OPAGG E 2,000,000 $ OTHER: AUTOMOBILE LMBIUTY COMBINED SINGLELMIT $ Ea aceidenl ANYAU 2I BODILY INURY(Par pawn) $ q OWNED SCHEDULED AUTOS ONLY AUTOS SAS 2056447520 04/01/2019 04/01/2020 BODILY INURY Per accieenq E HIRED HIRED NON-0WNK PROPEhtleAG AUTO$ ONLY AUTOS ONLY a Paccft tidcn $ Hired And Non owned $ 1.000,000 UMBRELLA UAB OCCUR FACHOCCURRENCE S AGGREGATE $ EXCESS LIAR CLAIMS -MADE DECO I I RETENTIONS $ MIDRKERSCOMPENSATION PER OTN- ANOEMPLOYER5UABILRY YIN X STATUTE ER E.L. EACHACCIOENT E 1,000,000 B ANY PROPRIETORIPARTNERIEXECUTIVE OFRCERIMEMBER EXCLUDED7 NIA EIG132510908 04/07/2019 04/07/2020 E.L. DISEASE -EA EMPLOYEE S 1,000,000 NH) (Msc.des —d DESC Guubv OF O DESCRIPTION OF OPERATIONS hebw El. DISEASE- POLICY LIMT S 1,000,000 Errors and Omissions Limit 2,G00.000 C P-001-000105411-01 04/012019 04101/2020 Deductible 5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, AE4111dnal Remaks Schedule, may he allchW If more apace Is required) GL Certificate Holder, Its officers• agents, employees and volunteers are Addisonal Insured as respects to operations of the Named Insured per form CG881 D0413, This Insurance is Primary 8 Non -Contributory to any other Insurance per form CG88100413. Notice of Cancellation. 30 days per CG897DO413. Endorsements apply only as required by current written contract on file. REVIEWED & APPROVED By RISk ANAGEMENT DIVISION CERTIFICATE HOLDER I MIIG All on.. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE AM MA M. LAM City of Santa Area Risk Management Div slon —I"P-eKPIRATION DATE THEREOF, NOTICE WILL EWORDANCE WITH THE POLICY PROVISIONS. BE DELIVERED IN 20 Civic Center Plaza, 4th FI AUTHOMMO REPRESENTATIVE Santa Ana CA 92702 '—� 4 01988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD