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CERTIFICATE OF LIABILITY INSURANCE DATE /DD/YYYY) 0311313/2020 THIS CERTIFICATE IS ISSUED ASA 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 ACONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, ANDTHE CERTIFICATE HOLDER. IMPORTANT. Itthe 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 ofthe Policy, certain policies may require an endorsement. Astatementon this certificate does not confer rightstothe certificate holder In lieu afsuch endorsement(s). PRODUCER CONTACT NAME: Karen Noteboom Karen Noteboom(971557E) 18837 Brookhurst St Ste 201 PHONE (A/C, NO, EXT): 714-847-4488 FAX (A/C, NO): 714-965-6796 E-MAIL Fountain Valley CA 92708-7302 ADDIN:ss: knoteboom@farmersagent.com INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURERA: Truck Insurance Exchange 21709 SUNRISE MEDICAL CENTER INC. INSURERS: Farmers Insurance Exchange 21652 INSURERC: Mid Century Insurance Company 21687 867 S TUSTIN ST INSURER D: ORANGE CA 92856 INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMEABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADORE INSD SUBR WVD POLICY NUMBER POLICYEFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y N 602378275 05/29/2019 / ✓ 05/29/2020 / ✓ EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES (Ea Occurrence) $ 500,000 MEDEXP(Anyoneperson) $ 5,000 PERSONAL &ADV INJURY $ 2.000,000 GENT AGGREGATELIMITAPPLIES PER: X POLICY ❑ PROJECT ❑ LOC OTHER: GENERALAGGREGATE $ 4,000,00 PRODUCTS-COMP/OPAGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANYAUTO OWNEDAUTOS SCHEDULED ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOSONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJ TRY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Peraccident) $ UMBRELLALIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/ Y/N EXECUTIVEOFFICER/MEMBER EXCLUDED? (Mandatory in NH) ITyes, describe under DESCRIPTION OF OPERATIONS below N/A REVIEWED &APPROVED By Risk MarvaC1 EMEN win DIVISION PER STATUTE OTHER $ E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City shall be excess and noncontributory. CERTIFICATE HOLDER CANCELLATION CITY OF SANTTAITA SHOULD ANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLED SEFORETHE EXPIRATION RISK MANAGEMENT DIVISION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 CIVIC CENTER PLAZA 4th FLOOR AUTHORIZED REPRESENTATIVE V ACORD25(2016/03) 31-1769 11-15 ©1988-2015 ACORD CORPORATION. All Rights Reserved The ACORD name and logo are registered marks of ACORD